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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846209
Report Date: 04/06/2023
Date Signed: 04/06/2023 10:53:06 AM

Document Has Been Signed on 04/06/2023 10:53 AM - 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:FERN ACADEMY EDUCATIONAL CHILDCAREFACILITY NUMBER:
364846209
ADMINISTRATOR:HE, LINGLINFACILITY TYPE:
850
ADDRESS:6921 SCHAEFER AVETELEPHONE:
(909) 696-9638
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY: 128TOTAL ENROLLED CHILDREN: 120CENSUS: 40DATE:
04/06/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Licensee Linglin HeTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA), Samuel Lopez arrived at the facility to conduct a Case Management inspection due to the request submitted for an increase in capacity. The facility is requesting to increase the Preschool Program capacity from 128 to 177. A Fire Clearance was granted on 2/15/2023.

The days and hours of operation will remain the same: Monday through Friday; 7:30am to 6:30pm.

LPA Lopez toured the facility and measured the rooms that are assigned to the Preschool Program. Based on the measurements taken, the following was determined:

Preschool Indoor Activity Areas
LPA has determined that there is sufficient space to accommodate 168 children.

Preschool Bathroom Fixtures
13 toilets x 15 = 195 children
23 sinks x 15 = 345 children

Preschool Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 133 children.
*Waiver will be required due to insufficient outdoor play space*

Limiting factor for preschool capacity is indoor square footage.
Preschool capacity is limited to 168 children.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2023
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FERN ACADEMY EDUCATIONAL CHILDCARE
FACILITY NUMBER: 364846209
VISIT DATE: 04/06/2023
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The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Bottled water is utilized to supply the facility children with drinking water in the indoor activity space
· Playgrounds are enclosed by appropriate fences
· Outdoor activity areas are supplied with age and size appropriate equipment
· 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.
· An adequate amount of cushioning material is in place under play equipment
· Adequate shade is provided
· Drinking water is provided in the outdoor play areas by individual cups filled with bottled water
· 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 of the facility and serves as the isolation area for ill children temporarily until parents arrive
· Toxins are locked
· Sign in/Sign out record was reviewed and meets regulation requirements
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· A review of staff records on 4/6/2023 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

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: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FERN ACADEMY EDUCATIONAL CHILDCARE
FACILITY NUMBER: 364846209
VISIT DATE: 04/06/2023
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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

No cited deficiencies during today's inspection.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



The following items need to be completed/corrected prior to approval of the increase in capacity:

1. Waiver for playground use due to insufficient square footage
2. Pictures of Pre-K 3 room set up with age appropriate equipment

Exit interview conducted and report was reviewed with Licensee Linglin He
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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