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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846399
Report Date: 06/08/2023
Date Signed: 06/08/2023 10:15:28 AM

Document Has Been Signed on 06/08/2023 10:15 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:DOMINGUEZ PRESCHOOL/SAN BERNARDINO CITY USDFACILITY NUMBER:
364846399
ADMINISTRATOR:SOTO,VERONICAFACILITY TYPE:
850
ADDRESS:135 S ALLEN ST.TELEPHONE:
(909) 880-6706
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92408
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/08/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Director Latashia KellyTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA), Samuel Lopez, toured proposed Preschool center, inside and out. A Fire Clearance was granted on 5/19/2023.
The days and hours of operation will be: 8:30am to 11:30am (AM Program) and 12:30pm to 3:30pm (PM Program)
Measurements were taken and the following was determined:

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

Preschool 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 the requested capacity (24) children.
*Waiver to be submitted for sharing with Kindergarten*

Limiting factor for preschool capacity is the Fire Clearance granted.
Preschool capacity is limited to 24 children.

The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Water fountains will supply drinking water in the indoor activity space however, the plan is to purchase water dispensers that use bottled water
· Playgrounds are enclosed by appropriate fences
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2023
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: DOMINGUEZ PRESCHOOL/SAN BERNARDINO CITY USD
FACILITY NUMBER: 364846399
VISIT DATE: 06/08/2023
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· 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 (rubber mat/material) is in place under play equipment
· Adequate shade is provided by removable/portable shade structure
· Drinking water is provided in the outdoor play areas by pitchers/jugs that will be filled and taken outside during play time
· Food will be prepared in the Elementary School Cafeteria and delivered to the classroom on a daily bases. Food will only be served in the classroom.
· The Elementary School Nurse's office is located at front entrance and will serve as the isolation area for ill children temporarily until parents arrive
· Toxins were NOT locked
· Medication that requires refrigeration will be stored in Nurse's office of the Elementary School. The other medication will be stored in the classroom, inside of a locked box
· Medication administration forms were reviewed
· First Aid kit was NOT available for inspection
· Sign in/Sign out record was reviewed and meets regulation requirements
· Component II Orientation was completed during this inspection
· The applicant 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 6/8/2023 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Director Latashia Kelly 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.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
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: DOMINGUEZ PRESCHOOL/SAN BERNARDINO CITY USD
FACILITY NUMBER: 364846399
VISIT DATE: 06/08/2023
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The applicant can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

LPA discussed AB 2370 and provided a copy of PIN 21-21.1-CCP which explains the requirement for lead testing of water. All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead.
For more information visit:
https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

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 also informed Director Latashia Kelly 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 Latashia Kelly 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 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: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
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: DOMINGUEZ PRESCHOOL/SAN BERNARDINO CITY USD
FACILITY NUMBER: 364846399
VISIT DATE: 06/08/2023
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The following items need to be completed/corrected prior to a license being issued:

1. Restrooms need to be cleared of all items stored
2. First Aid kit purchased
3. Broken electric outlet cover to be replaced
4. Hazardous items removed or made inaccessible
5. Carbon Monoxide Detector installed
6. Shade structure installed/set up
7. Parent Poster Board
8. Waiver for sharing of playground along with schedule(s)

Once all corrections have been made, with proof sent to licensing, and the Summer School session ends, the application will be submitted for approval with a maximum capacity of 24. As agreed, upon by the applicant, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied.

Exit interview conducted and report was reviewed with the Director Latashia Kelly.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
LIC809 (FAS) - (06/04)
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