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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845625
Report Date: 11/05/2021
Date Signed: 11/05/2021 04:04:39 PM

Document Has Been Signed on 11/05/2021 04:04 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:PRESTIGE PRESCHOOL ACADEMYFACILITY NUMBER:
364845625
ADMINISTRATOR:BRADSHAW, KRISTIEFACILITY TYPE:
850
ADDRESS:16427 SIERRA LAKES PKWYTELEPHONE:
(909) 401-2955
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 168TOTAL ENROLLED CHILDREN: 0CENSUS: 52DATE:
11/05/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Kristie BradshawTIME COMPLETED:
02:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kim Leung conducted a case management inspection at the facility this date on 11/5/2021. Facility is going through change of ownership. During the inspection, LPA toured the facility indoor and outdoor conducting inspection. Program activities and teacher-child interactions were observed. Criminal record clearances were verified. Staff #1's criminal record clearances are not associated to the facility or any other facility owned by the same licensee. Staff #1 was observed supervising children during this inspection. Director stated that the staff member has been working at the facility since December 2020.

See LIC809D for deficiency cited for failure to associate Staff #1 to the facility.

An exit interview was conducted with director Kristie Bradshaw. A Notice of Site visit was issued and must be posted for 30 days. Director was provided with a copy of the appeal rights (LIC9058 12/2015) and her signature on this report acknowledges receipt of those rights. A copy of this report was provided to the facility. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2021
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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Document Has Been Signed on 11/05/2021 04:04 PM - It Cannot Be Edited


Created By: Kim Leung On 11/05/2021 at 01:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: PRESTIGE PRESCHOOL ACADEMY
FACILITY NUMBER: 364845625

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2021
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearances. All individuals subject to a criminal record review ... shall prior to working...request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not met as evidenced by: Staff #1's criminal record clearances are not associated to the facility or any other facility owned by the
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Immediate CIVIL PENALTY OF $100 per day for 5 days with a total of $500 will be assessed. Complete request for associated was submitted during inspection. Director agreed to contact Licensing at (951) 782-4200 by 11/9/2021 to verify if the request has been completed.
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same licensee. Staff #1 was observed supervising children during this inspection. Director Kristie Bradshaw stated that completed request for association was submitted in December 2020 and on 6/2/2021 again via mail. However, director stated that there was no follow up done to ensure the request was received and completed.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Aaron Ross
LICENSING EVALUATOR NAME:Kim Leung
LICENSING EVALUATOR SIGNATURE:
DATE: 11/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2021


LIC809 (FAS) - (06/04)
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