<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300831
Report Date: 08/25/2023
Date Signed: 08/25/2023 12:18:07 PM

Document Has Been Signed on 08/25/2023 12:18 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:CVUSD-SAUL MARTINEZFACILITY NUMBER:
336300831
ADMINISTRATOR:ZAMUDIO,MARCELLAFACILITY TYPE:
850
ADDRESS:65705 JOHNSON STREETTELEPHONE:
(760) 848-1075
CITY:MECCASTATE: CAZIP CODE:
92254
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/25/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Martha CisnerosTIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Ana Noble, Licensing Program Manager Monica Cuddy and Assistant Deputy Karen Chang, conducted a pre-licensing inspection this date for a proposed Preschool Program. The days and hours of operation will be: Monday, Tuesday, Thursday and Friday 8:00 am to 2:30 pm, Wednesday 8:00 am to 2:00 pm. LPA met with Martha Cisneros, Licensing Specialist who led a tour of the facility at 10:10 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
· Drinking fountains, supply drinking water in the indoor activity space
· Playground is enclosed by a wrought iron fencing.
· 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.
· At the current time there is not adequate amount of cushioning material wood chips are in place under play equipment.
· Adequate shade is provided by canopy.
· Drinking water is provided in the outdoor play area by drinking fountain.
· Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies-Elementary School Cafeteria will be providing the snack/lunches.
· The office area is located near the entrance of the Elementary School Office.
· The children would be taken to the elementary school nurse's office/restroom will serve as the isolation area for ill children temporarily until parents arrive
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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: CVUSD-SAUL MARTINEZ
FACILITY NUMBER: 336300831
VISIT DATE: 08/25/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
·There is a working telephone located in the facility.
· Medication will be stored in the upper cabinet in a locked box which is inaccessible to children
· Storage area for toxins and poisons is locked, located in storage closet that is currently locked at this time.
· Medication administration forms were not reviewed
· First Aid kit is complete with all the required items.
· Sign in/Sign out record was reviewed and meets regulation requirements
· Parent Board located at the entrance of the classroom with all required forms.
· Carbon Monoxide Detector located on the wall near the back door leading to the playground.

Measurements were taken and the following was determined:

Preschool Indoor Activity Areas-
LPA has determined that there is sufficient space to accommodate 24 children.

Bathroom Fixtures
2 toilets x 15 = 30 children
5 sinks x 15 = 75 children

Preschool Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 120 children.
A waiver for sharing playground/outdoor/restroom and bus waiver for sign and out is pending approval.

Limiting factor for Preschool capacity Indoor space. The Fire Clearance granted on 8/7/2023. Preschool capacity is limited to 24 children.

During the inspection, the following was reviewed with Facility Representative:
· Component II Orientation was completed
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: CVUSD-SAUL MARTINEZ
FACILITY NUMBER: 336300831
VISIT DATE: 08/25/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
·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

· LPA reviewed Incidental Medical Services (IMS). For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department if the facility will provide the services. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (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


· 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.

Facility representative was reminded that 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A review of staff records on 8/24/2023 indicates that the applicant who is required to have caregiver background checks have received criminal record and child abuse index
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: CVUSD-SAUL MARTINEZ
FACILITY NUMBER: 336300831
VISIT DATE: 08/25/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
clearances or exemptions. The applicant can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations858@dss.ca.gov

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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), 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.


The following items need to be completed/corrected prior to a license being issued:

1. Add sufficient cushion material in the playground area in all fall zones, submit pictures and work order, as proof of correction.
2. Repair the playground equipment that has broken pieces of rubber padding that has expose metal material. Submit pictures and work order as proof of correction.
3. The two cars in the playground broken pieces missing. Repair and power wash or make inaccessible. Submit pictures of both play cars and work order as proof of correction.
4. Rubber pathway has broken pieces/areas that need to be repaired. Submit pictures and work order as proof of correction.
5. Pending Waiver approval for Shared playground/restroom, Sign In/Out at Bus stop and Administrative File.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: CVUSD-SAUL MARTINEZ
FACILITY NUMBER: 336300831
VISIT DATE: 08/25/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 24 children. As agreed upon by facility representative, Martha Cisneros, 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 Facility representative, Martha Cisneros, Licensing Specialist.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5