334816111-3-15-2023-09-CC-GCAO-CPXTRL-20230315145742

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334816111
Report Date: 03/15/2023
Date Signed: 03/15/2023 02:57:55 PM

Document Has Been Signed on 03/15/2023 02:57 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	KIDS TIME MONTESSORI		FACILITY NUMBER:	334816111
ADMINISTRATOR:	RENUKA SAMATH		FACILITY TYPE:	850
ADDRESS:	5524 GRAND AVENUE		TELEPHONE:	(951) 686-6473
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	31	CENSUS: 19	DATE:	03/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Renuka Samath		TIME COMPLETED:	03:00 PM

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On 03/15/2023 at 11:00AM Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to conduct a 1 year required annual inspection. LPA was granted entry by Renuka Samath. LPA toured the facility, inside and out, reviewed records and observed and/or discussed the following.

Days and hours of operation are Monday -Friday; 7AM- 5:30PM.

The inspection consisted of reviews of the following domains: Food Service; Reporting Requirements Physical Plant; Care and Supervision; Children Records; Staff Records; Staffing Ratio and Capacity and Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809D. Deficiencies were cited this visit.

The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days: (only if changes have been made)

1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility
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 with appropriate supervision during this inspection

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: KIDS TIME MONTESSORI	FACILITY NUMBER: 334816111
	VISIT DATE: 03/15/2023

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 For CCCs: Incidental Medical Services (IMS) policy was discussed. * Facility Representative was reminded that all adults 18 and over living or working in the home, 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 licensed 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. * LPA discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed Facility Representative 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.

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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility Representative, Renuka Samath.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: KIDS TIME MONTESSORI	FACILITY NUMBER: 334816111
	VISIT DATE: 03/15/2023

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Licensee was informed the Department has inspection authority per Health and Safety Codes.
Licensee provided the Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov
· 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.
· AB2370 – Lead Exposure, day care facilities, effective January 1, 2019 –
The bill requires that all Child Care Centers, operating in a building constructed before January 1, 2010, shall have their drinking water tested for excessive lead levels, on or after January 1, 2020, but no later than January 1, 2023. Child Care Centers must thereafter test their drinking water every five years after the date of the initial test.
During the inspection, LPA toured and obtained photos of the following water outlets identified with lead exceedances: Outlet B (11 ppb) which is located in children's bathroom Outlet C (50 ppb) located outside Outlet D (7.6 ppb) located on far side of building. LPA did not observed required signage posted at outlets for cessation of use. Facility placed signs during this visit.
* Facility implemented the following plan of action until formal remediation can be completed on water outlets: Covered water outlets and posted required signage for nonuse Facility is currently in process for repairs or considering removal of outlets affected. Notification of lead results is posted at the facility: front entry.

Facility has access to additional water resources: using water bottles/ water sports jugs for indoor/outdoor areas from outlet A. Due to facility water outlets testing above approved lead levels, a deficiency has been cited. See LIC809D.

· AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021

· AB2960 – Child care and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: KIDS TIME MONTESSORI	FACILITY NUMBER: 334816111
	VISIT DATE: 03/15/2023

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· Classrooms are clean, free of hazards and equipped with age appropriate furniture
· No weapons stored at the facility
· There are no accessible bodies of water present.
· Medications are stored inaccessible to children in the kitchen cabinet
· Hazards are stored inaccessible to children which include: Disinfectants, cleaners and other items that are dangerous. Poisons and toxins are locked.
· All floors are clean and safe.
· Bathrooms were observed to be safe, sanitary and in operating condition
· Outdoor activity areas/play grounds are enclosed by appropriate fences, free of hazards with age and size appropriate equipment in good condition: Yes
· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin
· Measures are taken to keep the facility free of flies, other insects and rodents
· Food is stored appropriately and protected from contamination
· Storage containers for solid waste, including moveable bins-have tight-fitting covers in good repair
· Menus are 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
· Uncontaminated drinking water shall be readily available both indoors and out.
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall: Facility has wood chips.
· Sign in/Sign out record was reviewed and meets regulation requirements: Yes
· A Staff member is present with current Pediatric CPR/First Aid which expires on 4/23
· Opening and closing staff member’s CPR/First Aid expires on 8/24
· Director completed Health and Safety Training on 07/5/2005
· Staff qualifications and files were reviewed and are complete: Yes
· Staff have received on the job training for housekeeping, sanitation and universal health precautions
· Children files were reviewed and are complete. Yes
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 02/15/2023

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/15/2023 02:57 PM - 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KIDS TIME MONTESSORI	FACILITY NUMBER: 334816111
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) the licensee did not comply with the section cited above in that the facility has been tested with the following lead exceedance values of 5.5 or above on water outlets: Outlet B (11 ppb); Outlet C (50 ppb); Outlet D (7.6 ppb). This is a potential health safety or personal rights risk to persons in care.
	POC Due Date: 04/15/2023
	Plan of Correction
1 2 3 4	Facility will submit plan of correction for remediation (repairs/retesting or removal) for water outlets affected. Facility will post notification of lead exceedances in front entry.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

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