334844722-9-20-2021-10-CC-ANOE-C6XV9H-20210917161421

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334844722
Report Date: 09/17/2021
Date Signed: 09/20/2021 11:36:20 AM

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:	VALLE VISTA ANNEX PRESCHOOL		FACILITY NUMBER:	334844722
ADMINISTRATOR:	CHUNG, NGOC HANH		FACILITY TYPE:	850
ADDRESS:	26205 FAIRVIEW AVE.		TELEPHONE:	(951) 765-1648
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	45	CENSUS: 1	DATE:	09/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Lori Hartigan		TIME COMPLETED:	04:25 PM

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	The licensee has applied to increase the capacity from 45 to 144 children to the Preschool Program. Licensing Program Analysts (LPAs) Ana Noble and Sumayya Habeebulla met with Lori Hartigan, Preschool Office Manager, purpose of visit was provided. LPAs toured the facility, inside and out, records were reviewed and the following was observed: The fire clearance was obtained and granted by the local Fire Department on 7/27/2021. Present during this visit were 1 children and 2 staff members. Upon arrival child engaged in age appropriate activities. Normal days and hours of operation are: Monday-Friday 8:00 am-11:00 pm for AM Classes and 12:30 pm-3:30 pm for PM Classes part classes. Full day M-F 8:00 AM to 2:30 pm. The following measurements were taken: Classroom Room 101: 39.05 x 22.83 (-64 restroom) = 827.5 Classroom Room 102: 39.05 x 22.83 (-64 restroom) = 827.5 Classroom Room 103: 39.05 x 22.83 (-64 restroom) = 827.5 Total space = 2482.5 divided by 35 = 71 children Facility is current capacity is 45 with the additional 3 classrooms the total capacity = 116 Total children toilets and sinks: 9 toilets x 15 = 135 children 9 sinks x 15 = 135 children The outdoor play area was observed and there is a sufficient amount of space to accommodate the requesting capacity. Limiting factor is the indoor space, 116 children.

SUPERVISOR'S NAME: Pauline Beschorner	TELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Ana Noble	TELEPHONE: (951) 295-5832
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: VALLE VISTA ANNEX PRESCHOOL	FACILITY NUMBER: 334844722
	VISIT DATE: 09/17/2021

NARRATIVE

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The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Water dispensers supply drinking water in the indoor activity space.
· Playgrounds are enclosed by appropriate fences
· Outdoor activity areas are supplied with age and size appropriate equipment
· 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.
· An adequate amount of cushioning material, artificial turf is in place under play equipment
· Adequate shade is provided
· Drinking water is provided in the outdoor play areas by water pitcher and disposable cups.
· Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies-School district cafetaria provided the meals.
· The office area is located and will serve as the isolation area for ill children temporarily until parents arrive
· School nurses office will also be used as the isolation bathroom and is conveniently located to the isolation area
· Toxins are locked
· Medication will be stored school nurses office and will be secured in a secure location.
· The Licensee states that they are providing Incidental Medical Services at this time. LPA informed the Licensee that prior to providing any incidental medical services that a written plan must be submitted to the licensing office.
· Medication administration forms were reviewed
· First Aid kit is complete
· Sign in/Sign out record was reviewed and meets regulation requirements
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov, and UnusualIncidentReportsDO10@dss.ca.gov
· A review of staff records on 9/17/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions

SUPERVISOR'S NAME: Pauline Beschorner	TELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Ana Noble	TELEPHONE: (951) 295-5832
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

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: VALLE VISTA ANNEX PRESCHOOL	FACILITY NUMBER: 334844722
	VISIT DATE: 09/17/2021

NARRATIVE

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The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov Associations_Disassociations858@dss.ca.gov

The following was also reviewed and discussed:
· Facility is providing IMS 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.
vAccess to forms & Regulations for a Child Care Center are online at www.ccld.ca.gov.
vPlease subscribe at www.childcareadvocatesprogram to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov
vThe Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

An exit interview was conducted and during the interview, the Preschool Office Manager, Lori Hartigan confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

No deficiency cited during this inspection. The license will be submitted for approval for a total of 116 children from the ages of 2 through 5

A notice of cite visit was provided and a copy of this report must be made available to the public for 3 years.

SUPERVISOR'S NAME: Pauline Beschorner	TELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Ana Noble	TELEPHONE: (951) 295-5832
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

LIC809 (FAS) - (06/04)

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