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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846190
Report Date: 04/19/2022
Date Signed: 04/19/2022 01:10:38 PM

Document Has Been Signed on 04/19/2022 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KIDDIE ACADEMY OF RANCHO CUCAMONGAFACILITY NUMBER:
364846190
ADMINISTRATOR:HOLMES, DAVID & ELIZABETHFACILITY TYPE:
830
ADDRESS:7220 VICTORIA PARK LANETELEPHONE:
(661) 644-4399
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Applicants David and Elizabeth Holmes and Director Heather JenkinsTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA), Samuel Lopez, arrived at the facility to conduct a Pre-licensing inspection, due to a change in ownership. The new ownership will retain the current name of the facility. LPA Lopez toured proposed Infant center, inside and out. A Fire Clearance was granted on 3/17/2022. The days and hours of operation will be: Monday through Friday, 6:30am to 6:00pm. Measurements were taken and the following was determined:

Infant Indoor Activity Areas
LPA has determined that there is sufficient indoor activity space to accommodate 28 children.

Infant Bathroom Fixtures
1 toilets x 15 = 15 children
4 sinks x 15 = 30 children

Infant Outdoor Activity Area:
LPA has determined that there is sufficient outdoor activity space to accommodate 26 children.

Limiting factor for infant capacity is the Fire Clearance. Infant capacity is limited to 24 children.

The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· There is a changing table within arm’s reach of a sink
· PUR/Brita water pitchers supply drinking water in the indoor activity space
· Playgrounds are enclosed by appropriate fences
· Outdoor activity areas are supplied with age and size appropriate equipment
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KIDDIE ACADEMY OF RANCHO CUCAMONGA
FACILITY NUMBER: 364846190
VISIT DATE: 04/19/2022
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· There are no accessible bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Toxins are locked
· An adequate amount of cushioning material (rubber mat) is in place under play equipment
· Adequate shade is provided
· Drinking water is provided in the outdoor play area by Igloos and cups
· 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 at the entrance and will serve as the isolation area for ill children temporarily until parents arrive
· Toxins are locked
· Medication will be stored in the front reception area and will be secured in a locked box
· Medication administration forms were reviewed
· First Aid kit is complete
· Sign in/Sign out record was reviewed and meets regulation requirements
· Component II Orientation was completed during the inspection
· The Director was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· Needs and Services plans were reviewed and discussed and must be updated at least quarterly or whenever needed.
· There are sufficient cribs (12) and/or mats for each child
· There is a separate napping area
· A review of staff records on 4/19/2022 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Director Heather Jenkins 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.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KIDDIE ACADEMY OF RANCHO CUCAMONGA
FACILITY NUMBER: 364846190
VISIT DATE: 04/19/2022
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The Director can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

This facility plans to provide 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. 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

LPA discussed the safe sleep regulations with Director Heather Jenkins and discussed the Child Care Licensing Safe Sleep webpage at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed Director Heather Jenkins 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.

LPA reviewed with Director Heather Jenkins 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.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KIDDIE ACADEMY OF RANCHO CUCAMONGA
FACILITY NUMBER: 364846190
VISIT DATE: 04/19/2022
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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

The application will be submitted for approval with a maximum capacity of 24.

Exit interview conducted and report was reviewed with the Applicants David and Elizabeth Holmes and Director Heather Jenkins.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC809 (FAS) - (06/04)
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