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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330909158
Report Date: 09/29/2022
Date Signed: 09/29/2022 11:56:52 AM


Document Has Been Signed on 09/29/2022 11:56 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 STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:BUNDY CANYON CHRISTIAN SCHOOLFACILITY NUMBER:
330909158
ADMINISTRATOR:PHYLLIS WALKERFACILITY TYPE:
850
ADDRESS:23411 BUNDY CANYON ROADTELEPHONE:
(951) 674-1254
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY:60CENSUS: 35DATE:
09/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Phyllis Walker TIME COMPLETED:
12:10 PM
NARRATIVE
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On September 29, 2022 at 8:15AM, Licensing Program Analyst (LPA), Alaina Wilburn conducted an annual inspection as part of a compliance review. A tour of the inside and outside of the facility was granted and the following was observed and/or noted:
· The following items were posted and updated where necessary:

- License
- Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
- Parent’s Rights Poster (PUB393)
- Personal Rights (LIC613A)
- Child Car Seat Law
- Menu

· The facility is operating within the limits as stated on the license.
· Ratios are being met during this inspection
· Classrooms are adequately equipped with age and size appropriate furniture and equipment and free of hazards
· There are no weapons present at the facility as stated by Director
· 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.
· Drinking water is provided in the indoor activity space by water dispenser with cups - and in the outdoor activity space by water pitcher with cups.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: BUNDY CANYON CHRISTIAN SCHOOL
FACILITY NUMBER: 330909158
VISIT DATE: 09/29/2022
NARRATIVE
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· Hazardous items are stored where inaccessible to children which include: Disinfectants, cleaning solutions and other items that are dangerous
· Poisons and toxins are locked and inaccessible to children
· All floors were observed to be clean and safe
· Bathrooms were observed to be safe, sanitary and in operating condition
· Playgrounds are enclosed by appropriate fences and free of hazards
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition
· Food preparation area is clean, free of litter and rubbish and free of rodents and other vermin
· Food is stored appropriately and protected from contamination
· All storage containers for solid waste were observed to have tight-fitting covers that are kept on, and in good repair
· Sign in/Sign out record was reviewed and meets regulation requirements
· Disaster drills are conducted at least every six months – last drill completed on 09/01/2022

A review of staff and children's records were conducted as part of this evaluation.
· Children’s records were found to be complete during this inspection.
· Staff records review indicates that all staff present meet minimum qualifications for the position for which they were hired.
· A staff member is present with current Pediatric CPR/First Aid which expires on 08/18/2023
· Opening and closing staff member’s CPR/First Aid expires on 08/18/2023
· Director completed Health and Safety Training

· A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: BUNDY CANYON CHRISTIAN SCHOOL
FACILITY NUMBER: 330909158
VISIT DATE: 09/29/2022
NARRATIVE
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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

The following items were discussed with the Director during inspection:

· Menus shall be posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request.
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall
· The Director was informed of their reporting requirements and provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations858@dss.ca.gov
Director was reminded that all adults 18 and over, 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.

On-line Licensing forms & regulations for a Child Care Center can be obtained on the Department’s website: www.ccld.ca.gov. Additionally, there is a link to “Receive Important Updates” located on the right side of the page, immediately above Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.



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
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: BUNDY CANYON CHRISTIAN SCHOOL
FACILITY NUMBER: 330909158
VISIT DATE: 09/29/2022
NARRATIVE
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See LIC 809D for cited deficiencies.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

An exit interview was conducted, and this report was reviewed with the Principal Phillip Walker. Appeal rights were discussed and provided during the exit interview.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/29/2022 11:56 AM - It Cannot Be Edited

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 STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: BUNDY CANYON CHRISTIAN SCHOOL
FACILITY NUMBER: 330909158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA Wilburn observed the licensee did not comply with the section cited above in 6 out of 8 Staff, S3, S4, S5, S6, S7 and S8 did not have proof of immunization's at time of visit, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2022
Plan of Correction
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Director will ensure that all staff have required immunization's (MMR, Pertussis & Influenza). Staff are allowed to decline the Flu Shot, but they must complete a waiver statement. Also, staff are allowed to do blood work, to confirm immunity from Measles, Mumps, Rubella and Pertussis, if they do not have a record of their immunization's. Director must submit proof to LPA by plan of correction date of 10/31/2022
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA Wilburn observed the licensee did not comply with the section cited above in 8 out of 8 Staff, S1 through S8 did not have proof of mandated reporter training certificates, which poses/posed a potential health, safety or personal rights risk to persons in care. The Director's(S1) certificate expired 11/05/2021
POC Due Date: 10/31/2022
Plan of Correction
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Director will ensure all staff complete the required training (General Training & Child Provider Care AB 1207) and submit proof to LPA by plan of correction date of 10/31/2022. The training could be completed at www.mandatedreporterca.com

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: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/05/2022 10:36 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/30/2022 03:25 PM

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 STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: BUNDY CANYON CHRISTIAN SCHOOL
FACILITY NUMBER: 330909158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA Wilburn observed the licensee did not comply with the section cited above in 6 out of 8 Staff, S2, S3, S4, S5, S6 and S7 did not have proof of immunization's at time of visit, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2022
Plan of Correction
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Director will ensure all staff obtain current first aid and cpr certification and submit proof to LPA by plan of correction date of 10/31/2022.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA Wilburn observed the licensee did not comply with the section cited above in 5 out of 8 Staff, S3, S5, S6, S7 and S8 did not have proof of a health screening and TB test with results at time of visit, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2022
Plan of Correction
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Licensee will ensure all staff have required health screening and TB test with results and submit proof to LPA by plan of correction date of 10/31/2022.

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: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 09/29/2022 11:56 AM - It Cannot Be Edited

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 STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: BUNDY CANYON CHRISTIAN SCHOOL
FACILITY NUMBER: 330909158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.2(d)(1-3)
An aide assisting a fully qualified teacher (as specified in Section 101216.1(c)) in the supervision of up to 18 preschool-age children, pursuant to Section 101216.3 shall meet the following requirements:


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA Wilburn observed the licensee did not comply with the section cited above in 4 out of 8 Teacher Aides, S5, S6, S7 and S8 did not have proof of transcripts to verify units and/or credits in Early Childhood Education or Child Developments at time of visit, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2022
Plan of Correction
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Director will submit transcripts or proof of enrollment in school, and submit proof of LPA by plan of correction date of 10/31/2022. A copy of Title 22 Regulations Section 101216.1 provided to Principal Phillip Walker
Type B
Section Cited
CCR
101217(a)
101217(a) Personnel Records. Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA Wilburn observed the licensee did not comply with the section cited above in 4 out of 8 staff had incomplete files and were missing required documents, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2022
Plan of Correction
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Director will ensure personnel records are complete and have all required paperwork and submit proof to LPA by POC date of 10/31/2022.

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: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
LIC809 (FAS) - (06/04)
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