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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701517
Report Date: 09/02/2022
Date Signed: 09/02/2022 03:40:15 PM

Document Has Been Signed on 09/02/2022 03:40 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:PINE VALLEY PRESCHOOLFACILITY NUMBER:
376701517
ADMINISTRATOR:CRYSTAL KREMENSKYFACILITY TYPE:
850
ADDRESS:7454 PINE BOULEVARDTELEPHONE:
(619) 473-9022
CITY:PINE VALLEYSTATE: CAZIP CODE:
91962
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/02/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Crystal KremenskyTIME COMPLETED:
01:00 PM
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On 9/2/22 at 8:30am, Licensing Program Analyst (LPA), Martha Malane arrived at the facility to conduct a pre-licensing inspection. LPA met with Facility Representative, Crystal Kremensky and was led on a tour the facility. The facility is located on the Pine Valley Middle School campus in the Preschool Room. Applicant is requesting a capacity of 15 preschool children (age 3 – 5 years). Applicant’s planned hours of operation are Monday - Friday 9:00am – 12:30pm. This is a Title 5 program.

The indoor space measured a total of 910.13 square feet which is sufficient to accommodate 26 children. The Preschool Room is equipped with age appropriate furniture and equipment including tables, chairs, cubbies, bookshelves and other materials for children. There is one (1) toilet and one (1) sink in the restroom located southeast of the classroom across the blacktop area and is for exclusive use by preschool children and sufficient to accommodate the requested capacity. Children shall be escorted to and from the restroom by a teacher. Drinking water is available outdoors and indoors via refillable water bottles brought from home. There is a separate restroom for staff located next to the classroom. The staff restroom will be utilized as an isolation restroom for children who are ill and an isolation area is located next to the director’s desk. Disinfectants and cleaning solutions are kept in an inaccessible cabinet next to the sink. The facility utilizes manual sign in and sign out sheets. Required documents are posted. There is an operational carbon monoxide detector.

The outdoor activity space was inspected and measured a total of 4,179 square feet which is sufficient to accommodate 55 children. The outdoor space is located on the east side of the campus. Children shall be escorted to and from the outdoor activity space by a teacher. Shade is provided through the use of trees. The preschool outdoor activity space is for exclusive use by preschool children.

See LIC809C continuation...
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PINE VALLEY PRESCHOOL
FACILITY NUMBER: 376701517
VISIT DATE: 09/02/2022
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The outdoor activity space is fenced, however there is not a permanent barrier between the preschool and the school age outdoor spaces; facility will utilize cones to separate the spaces. A plan of operation reflecting a plan to ensure there is no co-mingling of the preschool and school age children will be submitted. Proper supervision and placement of staff outside was discussed to ensure the safety of children at all times; children shall be escorted to and from the outdoor space by a teacher.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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 and provided: PIN 21-21-CCP: Lead Testing of Water in Licensed Child Care Centers Per AB 2370.

A Fire clearance for 24 children (age 3 – 5) was granted 8/5/22.

Prior to licensure the following is needed:
1) Proof of current mandated reporter training for director
2) Proof of complete first aid kit
3) Plan of operation for outdoor activity space

Exit interview was conducted with Facility Representative, Crystal Kremensky. Once the listed requirements have been met and proof submitted to CCL a provisional license may be granted and effective for 90 days pending director’s completion of Preventative Health Training.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022
LIC809 (FAS) - (06/04)
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