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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300733
Report Date: 06/23/2023
Date Signed: 06/23/2023 01:30:04 PM

Document Has Been Signed on 06/23/2023 01:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CALVARY MURRIETA PRESCHOOLFACILITY NUMBER:
336300733
ADMINISTRATOR:BURSCH, JENNIFERFACILITY TYPE:
850
ADDRESS:24275 MONROE AVETELEPHONE:
(951) 691-4900
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY: 89TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/23/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Kingsley BouldinTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA), Ana Noble conducted a pre-licensing inspection this date for a proposed Preschool License. The days and hours of operation will be: Monday -Friday 7:00 am to 6:00 pm. LPA met with Kingsley Bouldin who led a tour of the facility at 10:00 AM.
The facility was toured inside and out, and the following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Water dispenser with disposable cups, supply drinking water in the indoor activity space
· Playground is enclosed by a chain link fence.
· Outdoor activity area is supplied with age and size appropriate equipment
· There are no accessible bodies of water present. If wading pools or similar products are used, they must be emptied immediately after use and stored in an upright position.
· An adequate amount of cushioning material rubber padding is in place under play equipment.
· Adequate shade is provided by umbrellas.
· Drinking water is provided in the outdoor play area by Igloo and disposable cups.
· Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies in the Elementary cafeteria.
· The office area is located in the rear of Room 201.
· The Director's office will serve as the isolation area for ill children temporarily until parents arrive
· There is a working telephone located in the facility.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CALVARY MURRIETA PRESCHOOL
FACILITY NUMBER: 336300733
VISIT DATE: 06/23/2023
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·Medication will be stored in the Director's office in locked cabinet which is inaccessible to children
· Storage area for toxins and poisons is locked, located in storage closet.
· First Aid kit is complete with all of the required items.
· Sign in/Sign out record are electronic on a ipad and was reviewed and meets regulation requirements
· Parent Board located upon entering every classroom by sign in and out area.
· Carbon Monoxide Detector located Room 201.

Measurements were taken and the following was determined:
Preschool Indoor Activity Areas-
LPA has determined that there is sufficient space to accommodate 68 children.
Bathroom Fixtures
8 toilets x 15 = 120 children
8 sinks x 15 = 120 children
Preschool Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 23 children.
A waiver for sharing playground/outdoor activity space and restrooms is pending approval.
Limiting factor for Preschool capacity is the indoor space. The Fire Clearance was granted on June 6, 2023. Preschool capacity is limited to 68 children.

Licensee was reminded all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CALVARY MURRIETA PRESCHOOL
FACILITY NUMBER: 336300733
VISIT DATE: 06/23/2023
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA reviewed with licensee the LIC 311A, Forms/Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

On this date, 2/13/2023, The California Attorney General – Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California’s Megan’s Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN),
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CALVARY MURRIETA PRESCHOOL
FACILITY NUMBER: 336300733
VISIT DATE: 06/23/2023
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Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

During the inspection, the following was reviewed with Facility Representative:
· Component II Orientation was completed
· The applicant was informed of their reporting requirements and provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
· The importance of checking for recalled infant (children) devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant (children) devices with the CPSC to be notified of any recalls on their purchased equipment.

· Provider Information Notice (PIN) 22-20-CCP: Resources and Requirements on Lead Testing in Child Care

· The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.



For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Before licensure, the following needs to be corrected/completed:
1. Waivers for shared playground and restroom with elementary children pending approval.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CALVARY MURRIETA PRESCHOOL
FACILITY NUMBER: 336300733
VISIT DATE: 06/23/2023
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Per the Fire Clearance Inspection Request, STD the Fire Marshal specified the following age group for the following rooms: Room 201 (32-42 months) Room 202 (42 months-4 years) Room 203 (4-5 years). During the inspection the applicant contact the Fire Marshal to see if this could be removed. Per the Fire Marshal, he would verify and send an amended copy of the STD850, if this was possible. If not the age group specified above will be indicated on license.

Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 68 children. As agreed, upon by Applicant, Kingsley Bouldin, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied.

If all corrections are approved and facility licensed, you must have the drinking water outlets used for drinking and cooking tested for lead and post the results within 180 days of licensure.

Exit interview conducted and report was reviewed with the Applicant, Kingsley Bouldin.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
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