334840528-9-6-2023-10-CC-AWIN-CVEQPQ-20230906122108

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334840528
Report Date: 09/06/2023
Date Signed: 09/06/2023 12:21:19 PM

Document Has Been Signed on 09/06/2023 12:21 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	LEUSD WILLIAM COLLIER PRESCHOOL		FACILITY NUMBER:	334840528
ADMINISTRATOR:	STEVE BEHAR		FACILITY TYPE:	850
ADDRESS:	20150 MAYHALL DRIVE		TELEPHONE:	(951) 253-7630
CITY:	WILDOMAR	STATE: CA	ZIP CODE:	92595
CAPACITY:	24	CENSUS: 20	DATE:	09/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Shawna Passmore, Interim Program Supervisor		TIME COMPLETED:	10:30 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	At 8:20AM on September 6, 2023, 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 Site Supervisor · 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 a filling station with cups - and in the outdoor activity space by a filling station with cups. · Medications are stored where inaccessible to children (locked in cabinet classrooms) · Hazardous items are stored where inaccessible to children which include disinfectants, cleaning solutions and other items that are dangerous

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEUSD WILLIAM COLLIER PRESCHOOL	FACILITY NUMBER: 334840528
	VISIT DATE: 09/06/2023

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
26
27
28
29
30
31
32

· Poisons and toxins are locked and inaccessible to children
· All floors were observed to be safe and clean.
· 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 was conducted on 08/29/23

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 record 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 08/05/2025.
· Opening and closing staff member’s CPR/First Aid expires on 08/05/2025
· 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send them email inquiries 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.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEUSD WILLIAM COLLIER PRESCHOOL	FACILITY NUMBER: 334840528
	VISIT DATE: 09/06/2023

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
26
27
28
29
30
31
32

Program Supervisor was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP)

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

IF A FACILITY IS CURRENTLY PROVIDING IMS, USE AS FOLLOWS:

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 PIN 22-02-CCP.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, are available at: https://www.ada.gov/resources/child-care-centers/

Program Supervisor was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEUSD WILLIAM COLLIER PRESCHOOL	FACILITY NUMBER: 334840528
	VISIT DATE: 09/06/2023

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
26
27
28
29
30
31
32

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: 951-782-4200

See LIC 809D for cited deficiencies. Technical Violation Issued.

During the exit interview, the Program Supervisor Shawna Passmore, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and this report was reviewed with the Program Supervisor Shawna Passmore. Appeal rights were discussed and provided during the exit interview.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

Page: 4 of 6

Document Has Been Signed on 09/06/2023 12:21 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEUSD WILLIAM COLLIER PRESCHOOL	FACILITY NUMBER: 334840528
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

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
1 2 3 4	Based on LPA Wilburn's record review, the licensee did not comply with the section cited above in 1 out of 4 Staff, Staff #4 does not have a personnel record, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/22/2023
	Plan of Correction
1 2 3 4	Staff #4 is a substitute teacher's assistant, but the district did not provide a personnel record for staff #4 prior to employment. Director will submit a copy of a complete record for S4 to LPA by plan of correction date of 09/22/2023.

Type B

Section Cited

CCR

101216(g)(1)

All personnel, including the licensee, administrator and volunteers, shall be in good health and shall be physically and mentally capable of performing assigned tasks. (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
1 2 3 4	Based on LPA Wilburn's record review, the licensee did not comply with the section cited above in 1 out of 4 Staff, Staff #4 did not have proof of a health screening with TB test and results, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/22/2023
	Plan of Correction
1 2 3 4	Director will ensure that Staff #4 (S4) has a current health screening with TB test and results and submit proof or confirmation of appointment by plan of correction date of 09/22/2023.

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: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 09/06/2023 12:21 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEUSD WILLIAM COLLIER PRESCHOOL	FACILITY NUMBER: 334840528
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA Wilburn's record review, the licensee did not comply with the section cited above in 1 out of 4 Staff, Staff #4, did not have proof of the required immunization's at time of visit, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/22/2023
	Plan of Correction
1 2 3 4	Director will submit a copy of the required immunization's to LPA by plan of correction of 09/22/2023.

Type B

Section Cited

CCR

101216(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
1 2 3 4	Based on LPA Wilburn's record review, the licensee did not comply with the section cited above in 2 out of 4 Staff (Staff #3 and Staff #4) do not have proof of current First Aid/CPR certification at time of visit, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/22/2023
	Plan of Correction
1 2 3 4	Director will ensure that Staff #3 and Staff #4 have current First Aid/CPR and submit proof to LPA by plan of correction date of 09/22/2023.

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: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

Page: 6 of 6