334805816-12-23-2020-09-CC-EJOS-BWL3EB-20201223171052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334805816
Report Date: 12/23/2020
Date Signed: 12/23/2020 05:11:51 PM

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:	LIFE CHRISTIAN ACADEMY		FACILITY NUMBER:	334805816
ADMINISTRATOR:	CANDICE LUCKETT-JACK		FACILITY TYPE:	850
ADDRESS:	3270 RUBIDOUX BLVD.		TELEPHONE:	(951) 684-3639
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY:	45	CENSUS: 6	DATE:	12/23/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Candice Luckett-Jack & Sheila Brice		TIME COMPLETED:	10:10 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Elyse Jones, Kim Leung, and Corey Hall conducted a Case Management inspection for the purpose of an increase of capacity request. Upon arrival, LPAs met with facility Director Candice Luckett-jack and Administrative Assistant Sheila Brice. LPAs observed six children present as the facility in the "green room". Measurements for the yellow, green, blue, and red rooms were taken. LPAs observed an age appropriate play structure on the preschool playground. Fire clearance approved on 11-23-2020 There is a sufficient amount of indoor and outdoor activity space to accommodate the requested capacity of 60 children. 4 toilets x 15 = 60 children 8 sinks x 15 = 120 children The carbon-monoxide detector in the "red room" was tested by facility staff during this inspection and found to be functioning. Files were sent to LPA Jones via email after the visit. A review of the staff records and a review of a sampling of children's records were conducted as part of this inspection. See Confidential Names List (LIC811) The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days:

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse Jones	TELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020

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: LIFE CHRISTIAN ACADEMY	FACILITY NUMBER: 334805816
	VISIT DATE: 12/23/2020

NARRATIVE

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1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization (only if changes have been made)
5. LIC 308 Designation of Administrative Responsibility (only if changes have been made)
· The following items have been posted and are 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 terms of the license
· Ratios were met during this inspection
· Appropriate supervision was provided during this inspection
· Classrooms are equipped with age appropriate furniture and equipment in good condition
· Classrooms are clean and free of hazards
· All floors shall be kept clean and safe
· No weapons stored at the facility
· 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.
· There are NO Medications stored at the facility at this time.
· Hazards are stored where inaccessible to children which includes: disinfectants, cleaning solutions and other items that are dangerous to children
· Poisons and toxins are locked
· Bathrooms were observed to be safe, sanitary and in operating condition

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse Jones	TELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020

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: LIFE CHRISTIAN ACADEMY	FACILITY NUMBER: 334805816
	VISIT DATE: 12/23/2020

NARRATIVE

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· 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, rubbish and free of rodents and other vermin
· Food is stored appropriately and protected from contamination
· All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair.
· Uncontaminated drinking water shall be readily available both indoors and out and are provided by a gallons of water and disposable paper cup
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall (wood chips)
· Sign in/Sign out record was reviewed and meets regulation requirements
· Opening and closing staff member’s (Director, Candace Luckett-Jack) CPR/First Aid expires on 4/21/2021
· Records were reviewed ensuring the children’s files contain the names and contact information of authorized representatives and others who can assume responsibility for the child when necessary
· Records were reviewed ensuring that the staff files contain documentation of the educational background, training and/or experience required
· Documentation of fire & earthquake drills to be conducted every six months- last conducted 12-21-2020
· A review of staff records on 12-23-2020 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

See LIC 809D for deficiencies cited.

The application for Capacity of Increase will be submitted to the Department for approval.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse Jones	TELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020

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: LIFE CHRISTIAN ACADEMY	FACILITY NUMBER: 334805816
	VISIT DATE: 12/23/2020

NARRATIVE

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An exit interview was conducted with Administrative Assistant, Sheila Brice via telephone.
LPA Jones provided the Administrative Assistant with a copy of this report, Appeal Rights,
LIC 811 and a Notice of Site Visit via email with an electronic “read receipt” . LPA asked the Administrative Assistant to acknowledge receipt of the email by replying with "I am acknowledging I have received a copy of the LIC 809 and Notice of Site Visit dated 12-23-2020. A copy of this report was emailed to the Administrative Assistant after the call.

LPA asked the Administrative Assistant to print, sign and scan a copy back to her for the facility file. The Notice of Site Visit must be posted at a prominent location for the next 30 days.

During the inspection, Administrative Assistant confirmed there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

This report must be made available at the facility for 3 years for public review upon request

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse Jones	TELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: LIFE CHRISTIAN ACADEMY	FACILITY NUMBER: 334805816
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/23/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/18/2021 Section Cited	1 2 3 4 5 6 7	AB1207-...all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years... Existing licensees must meet requirements by March 30, 2018. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on the observation/record review. Three of three staff files reviewed , the Mandated Reporter Training certificates were not available for review. The Licensee did not meet Health & Safety Code 1596.8662, which poses a potential Health, Safety & Personal Rights risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse Jones	TELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2020

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020

LIC809 (FAS) - (06/04)

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