336300846-7-24-2023-10-CC-ANOE-CU2RNQ-20230724131042

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336300846
Report Date: 07/24/2023
Date Signed: 07/24/2023 01:10:52 PM

Document Has Been Signed on 07/24/2023 01:10 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:	MURRIETA VALLEY USD/ANTELOPE HILLS STATE PRESCH		FACILITY NUMBER:	336300846
ADMINISTRATOR:	ISRAELSEN, KATHLEEN		FACILITY TYPE:	850
ADDRESS:	36105 MURRIETA OAKS AVE		TELEPHONE:	(951) 445-4110
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY: 17	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/24/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Kathleen Israelsen		TIME COMPLETED:	01:25 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 conducted a pre-licensing inspection this on July 24, 2023 for a proposed Preschool Program. The days and hours of operation will be: Monday-Friday 7:00 am-3:30 pm. LPA met with Kathleen Israelsen who led a tour of the facility at 12:00 PM. 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 fountain, supply drinking water in the indoor activity space · Playground is enclosed by a 4 feet chain link and 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. · An adequate amount of cushioning material rubber padding is in place under play equipment · Adequate shade is provided by canopy. · Drinking water is provided in the outdoor play area by water dispenser and disposable cups. · Elementary School cafeteria provides the meals. Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies · The office area is located near the entrance the elementary school administrative building.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: MURRIETA VALLEY USD/ANTELOPE HILLS STATE PRESCH	FACILITY NUMBER: 336300846
	VISIT DATE: 07/24/2023

NARRATIVE

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·Quiet corner/Staff area will serve as the isolation area for ill children temporarily until parents arrive
· There is a working telephone located in the facility.
· Medication will be stored in the cabinet in lock box which is inaccessible to children
· Storage area for toxins and poisons is locked, located in classroom in cabinet.
· Medication administration forms were 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 on the front wall by dry board with all required forms.
· Carbon Monoxide Detector located above the cabinet on the dry board wall.

Measurements were taken and the following was determined:

Preschool Indoor Activity Areas-
LPA has determined that there is sufficient space to accommodate 16 children.

Bathroom Fixtures
2 toilets x 15 = 30 children
3 sinks x 15 = 45 children

Preschool Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 16 children.
A waiver for sharing playground for outdoor activity space is pending approval.

Limiting factor for Preschool is the requested capacity of 16 children. The Fire Clearance inspection was conducted on July 13, 2023. LPA Noble has not received copy of Fire Clearance, STD850 as of this date. Preschool capacity is limited to 16 children.

Applicant 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

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: MURRIETA VALLEY USD/ANTELOPE HILLS STATE PRESCH	FACILITY NUMBER: 336300846
	VISIT DATE: 07/24/2023

NARRATIVE

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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.

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

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Error! Hyperlink reference not valid.. 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 applicant 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 applicant of the importance of checking for recalled devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all devices with the CPSC to be notified of any recalls on their purchased equipment.

On this date, 6/29/2023, 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.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: MURRIETA VALLEY USD/ANTELOPE HILLS STATE PRESCH	FACILITY NUMBER: 336300846
	VISIT DATE: 07/24/2023

NARRATIVE

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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.

Applicant 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), 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/Designee:
· 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 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.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: MURRIETA VALLEY USD/ANTELOPE HILLS STATE PRESCH	FACILITY NUMBER: 336300846
	VISIT DATE: 07/24/2023

NARRATIVE

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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. Fire Clearance, STD850 from the Fire Department.
2. Waiver approval for shared playground with Elementary Children.
3. Replace or Repair the holes/cracks in the cushioning material underneath the play structure, submit work order.

Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 16 children. As agreed, upon by facility representative/designee, Kathleen Israelsen, 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, Kathleen Israelsen.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC809 (FAS) - (06/04)

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