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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845927
Report Date: 12/16/2020
Date Signed: 12/16/2020 05:23:52 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:STONEBRIDGE CHRISTIAN ACADEMYFACILITY NUMBER:
334845927
ADMINISTRATOR:KATHERINE PASLEY-BARROWMANFACILITY TYPE:
840
ADDRESS:4193 BLUFF STREETTELEPHONE:
(714) 402-7945
CITY:NORCOSTATE: CAZIP CODE:
92860
CAPACITY:24CENSUS: 0DATE:
12/16/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Katherine PasleyTIME COMPLETED:
05:20 PM
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***Please note: Due to COVID-19, a tele-inspection is being conducted in lieu of an in-person/physical inspection***

Licensing Program Analysts (LPAs), Samuel Lopez and Corey Hall conducted a virtual tour of the classrooms (Green & Orange), inside and out, via FaceTime. These classrooms are proposed to be utilized by the School Age program. A fire clearance was granted on 9/1/2020. The days and hours of operation will be: Monday through Friday, 6:30am to 6:30pm. Measurements of these two classrooms were previously taken on 9/17/2012:

School-Age Indoor Activity Areas
LPA has determined that there is sufficient space to accommodate 17 children.

Please note that a waiver was requested, and is pending approval, for the use of the classrooms #4 (Orange) or #6 (Green), when they are not in use by the Preschool children.

Also, when School Age children are present, the Preschool license capacity will be reduced by 17 children and therefore only have the capacity for 103 Preschool Children.

School-age Bathroom Fixtures
2 toilets x 15 = 30 children
2 sinks x 15 = 30 children
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2020
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: STONEBRIDGE CHRISTIAN ACADEMY
FACILITY NUMBER: 334845927
VISIT DATE: 12/16/2020
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School-Age Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 17 children.
Please note that a waiver has been submitted for the School Age and Preschool programs to share the playground

Limiting factor for school-age capacity is the amount of square footage of the classroom(s). School-age capacity is limited to 17 children.

The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Water fountains supply drinking water in the indoor activity space - cups are provided for use
· Playground is enclosed by an appropriate fence. Please Note: The Santa Ana River is located directly behind the playground. LPAs observed an 8 foot wrought iron fence that surrounds the playground and meets Title 22 at this time.
· Outdoor activity area is supplied with age and size appropriate equipment
· The facility has a splash pad located on the playground that was previously approved for usage by the Department. Located on the floor of the splash pad is a drain that does not allow water to accumulate.
· An adequate amount of cushioning material (Rubber/Foam and Artificial Turf) is in place under play equipment
· Adequate shade is provided
· Drinking water is provided in the outdoor play area by drinking fountains and cups are provided.
· Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies
· The first aid room is located at the front entrance and will serve as the isolation area for ill children temporarily until parents arrive
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2020
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: STONEBRIDGE CHRISTIAN ACADEMY
FACILITY NUMBER: 334845927
VISIT DATE: 12/16/2020
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· Medication will be stored in the front office and is inaccessible to children
· Storage area for toxins and poisons is locked.
· The Licensee/Applicant states that they will provide Incidental Medical Services when needed. 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 kits are complete and are available throughout the facility/classrooms
· Sign in/Sign out record was reviewed and meets regulation requirements
· Component II Orientation was completed during this inspection
· A review of staff records on 12/16/2020 indicates that the Licensee or designated individual who is required to have caregiver background checks have received criminal record and child abuse index clearances or exemptions, all other staff have required documentation in their personnel files.
The Licensee/Applicant can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
· The "Notification of Parent's Rights" (PUB393 dated [8/02]) poster was previously provided to the applicant and they were advised that it must be posted in an area of the facility accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.
· The Licensee/Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· The Licensee/Applicant was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2020
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: STONEBRIDGE CHRISTIAN ACADEMY
FACILITY NUMBER: 334845927
VISIT DATE: 12/16/2020
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· Applicant knowa facility plans to provide IMS This facility plans to provide Incidental Medical Services – IMS. 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 more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

The following was also reviewed and discussed:
v AB 2621 – Public Information effective January 1, 2015 – The Department shall post licensing reports for Child Care Facilities on it’s internet Web site. This information is to be updated at least monthly on the website and will span the preceding five-year period.
v AB 2236 – Civil Penalties, effective July 1, 2015 – Enacts new civil penalties in cases where the Department determines that a violation of licensing standards resulted in the death or serious injury, or constitutes physical abuse of a child in care. The bill establishes an appeal procedure specific to these civil penalties. The bill also expands the scope of the Child Health and Safety Fund in order to assist parents in securing alternative child care when a Child Care Center license has been suspended or revoked. These civil penalty amounts are scaled in relation to the total capacity of all of the licensee’s facilities and not just the specific facility cited or limited to that facility type.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2020
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: STONEBRIDGE CHRISTIAN ACADEMY
FACILITY NUMBER: 334845927
VISIT DATE: 12/16/2020
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v AB 2386 – Carbon Monoxide Detector Regulations, effective January 1, 2015 – In accordance with California Health and Safety Code Section 1975.543 - Every child 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
v SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 - it eliminates the exemption from existing specified immunization requirements based upon personal beliefs, and only allows an exemption from future immunization requirements deemed appropriate by the State Department of Public Health or a medical professional for medical reasons.
v AB290 – Child Nutrition, effective January 1, 2016 - In accordance with California Health and Safety Code Section 1596.866 - each child care center shall have at least one person employed who was completed one hour of childhood nutrition training as part of the preventive health practices course or courses.
v SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. If employees/volunteers are receiving the influenza vaccination they must do so between August 1 and December 1 of each year.
v AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017 – For failing to correct a violation the civil penalty is increased to $100 per day for EACH violation until corrected; For failing to correct a repeated violation the civil penalty is increased to $250 immediately assessed , and $100 per day afterwards for EACH repeated violation until corrected; For an Immediate Risk violation the civil penalty is increased to $500 immediately assess, and $100 per day for EACH violation after that until corrected; For any repeated Immediate Risk violations the civil penalty is increased to $1,000 immediately assess, and $100 per day afterwards for EACH repeated violation until corrected.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2020
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: STONEBRIDGE CHRISTIAN ACADEMY
FACILITY NUMBER: 334845927
VISIT DATE: 12/16/2020
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v NOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.
v Access to forms & Regulations for a Child Care Center are online at www.ccld.ca.gov.
v Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive updates for.
v The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

The following items need to be completed/corrected prior to a license being issued:

1. Waivers for classroom, multi-purpose room, and playground sharing are pending approval

Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 17. As agreed upon by the applicant, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied.

An exit interview was conducted and a copy of this report was sent, via email, to Katherine Pasley.

A copy of this report must be made available to the public, at the facility site, for 3 years.

***This report was sent via email on 12/16/2020. Katherine has agreed to reply or to acknowledge that she has received it, via read receipt. This will serve as Katherine's signature***

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2020
LIC809 (FAS) - (06/04)
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