334845139-10-13-2023-09-CC-PORS-CWKUBR-20231013152646

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334845139
Report Date: 10/13/2023
Date Signed: 10/13/2023 03:26:58 PM

Document Has Been Signed on 10/13/2023 03:26 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	STAVNESS EARLY LEARNING		FACILITY NUMBER:	334845139
ADMINISTRATOR:	STAVNESS, MICHELLE		FACILITY TYPE:	850
ADDRESS:	35275 SINGLETON RD		TELEPHONE:	(909) 226-1048
CITY:	CALIMESA	STATE: CA	ZIP CODE:	92320
CAPACITY:	45	CENSUS: 20	DATE:	10/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:07 AM
MET WITH:	Licensee Michelle Stavness		TIME COMPLETED:	03:40 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	On the date and time listed, Licensing Program Analyst (LPA) Perla Ordones conducted a required/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: A review of staff and children's records were conducted as part of this evaluation. The licensee/director is asked to update the following documents, if applicable, and submit to licensing within 30 days: - LIC 500 Personnel Report - LIC 610 Emergency & Disaster Plan - Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made) - LIC 309 Administrative Organization (only if changes have been made) - 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 with the limits as stated on the license. · Ratios are being met during this inspection.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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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Document Has Been Signed on 10/13/2023 03:26 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: STAVNESS EARLY LEARNING	FACILITY NUMBER: 334845139
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.954

Licensure Requirements

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above as it was determined that the detector was inoperable due to nonfunctional batteries when the Licensee examined the unresponsive carbon monoxide detector which posesd a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2023
	Plan of Correction
1 2 3 4	During the facility visit, Licensee replaced the old carbon monoxide detector with a new plug in and was able to successfully test the carbon monoxide detector. Plan of Correction (POC) was cleared during the visit.

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
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as both the Licensee and S3 were missing current non-expired Mandated Reporter Child Care Providers (AB1207) training certificates which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2023
	Plan of Correction
1 2 3 4	Licensee agrees to complete the AB1207 training by the Plan of Correction (POC) due date. Licensee also agrees to send proof of the POC by the end of the business day on the POC due date of 10/27/2023. 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: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: STAVNESS EARLY LEARNING	FACILITY NUMBER: 334845139
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101172(a)(2)

(a) All child care centers where water for human consumption is from a private source shall meet the following requirements: (2) Subsequent to initial licensure, the licensee shall provide evidence of a bacteriological analysis of the private water supply as frequently as is necessary to ensure the safety of the children, but no less frequently than specified in the following table: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as the facility has been utilizing a water well located on the premises to provide drinking water for children, but the facility did not have a bacteriological water analysis document on file that provided proof that the water is safe for human consumption which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2023
	Plan of Correction
1 2 3 4	Licensee agrees to obtain a bacterial water analysis of the water well on the premises by the Plan of Correction (POC) due date. Licensee agrees to halt the use of the water well in the meantime and will provide drinking water to children via bottled water. Licensee agrees to send proof of the POC by the end of the business day on the POC due date of 10/27/2023.

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: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: STAVNESS EARLY LEARNING	FACILITY NUMBER: 334845139
	VISIT DATE: 10/13/2023

NARRATIVE

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· Classrooms are adequately equipped with age and size appropriate furniture and equipment and free of hazards.
· During the facility tour, LPA asked Licensee to test Carbon Monoxide detector as part of the annual inspection. When Licensee went to test the detector, nothing happened and there was no light to show that the detector was operable. It was determined that the detector had nonfunctional batteries. Licensee replaced batteries during visit.
· There are no weapons present at the facility as stated by Licensee Michelle Stavness.
· Facility has a water well on the premises which is located inside a locked shed and made inaccessible to day-care children. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Hazards are stored where inaccessible to children which include: Disinfectants, cleaning solutions and other items that are dangerous.
· Poisons and toxins are locked.
· All floors shall 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. However, during the facility tour, LPA observed that some of the animal shelters that children have access to have wear and tear that could pose a danger to children, such as weathered wood that may cause splinters. Licensee stated that the shelter in question would be torn down as the animals were being relocated to a secondary pen that is not experiencing wear and tear.
· Food for children is brought from home per Licensee.
· All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair.
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall: wood chips are utilized by the facility.
· Sign in/Sign out record was reviewed and meets regulation requirements.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: STAVNESS EARLY LEARNING	FACILITY NUMBER: 334845139
	VISIT DATE: 10/13/2023

NARRATIVE

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· Uncontaminated drinking water is not readily available both indoors and outdoors. During the inspection, LPA received information that the facility has been utilizing a water well located on the premises to provide drinking water for children. However, the facility did not have a bacteriological water analysis document on file that provided proof that the water is safe for human consumption. LPA brought this to the attention of the Licensee who stated they would have the well tested as soon as possible and would utilize bottled water for the children to drink for the time being.
· A Staff member is present with current Pediatric CPR/First Aid which expires on 08/2024.
· Opening and closing staff member’s CPR/First Aid expires on 08/2024.
· Director completed Health and Safety Training – 08/27/2016.
· A review of children’s records was conducted, and records were found to be complete during this inspection.
· Disaster drills to be conducted every six months – last drill conducted on 09/14/2023.

· 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
· A review of staff records on 10/13/2023 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

· A review of staff records indicates that all staff present meet minimum qualifications for the position for which they were hired. However, during record review, LPA observed that both the Licensee and S3 were missing current non-expired Mandated Reporter Child Care Providers (AB1207) training certificates. LPA brought this to the attention of the Licensee who stated that they would submit proof of the AB1207 for both the Licensee and S3 upon completion.

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).

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: STAVNESS EARLY LEARNING	FACILITY NUMBER: 334845139
	VISIT DATE: 10/13/2023

NARRATIVE

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

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) 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/.

Licensee 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, or transfer their existing 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.

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 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/inspection-process.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: STAVNESS EARLY LEARNING	FACILITY NUMBER: 334845139
	VISIT DATE: 10/13/2023

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Licensee 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. 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.

To access on-line Licensing forms & Regulations for a Child Care Center please visit: www.ccld.ca.gov.

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

See LIC809-D for cited deficiencies.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Michelle Stavness.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC809 (FAS) - (06/04)

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