334846059-9-7-2021-09-CC-KLEG-C6MSZJ-20210907141913

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334846059
Report Date: 09/07/2021
Date Signed: 09/07/2021 02:19:44 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:	COUNTRYSIDE MONTESSORI ACADEMY		FACILITY NUMBER:	334846059
ADMINISTRATOR:	WICKREMESINGHE, MANOJ		FACILITY TYPE:	850
ADDRESS:	2266 GRIFFIN WAY		TELEPHONE:	(951) 340-2821
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	90	CENSUS: 41	DATE:	09/07/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:19 AM
MET WITH:	Manoj Wickremesinghe, Kaneez Jaffery		TIME COMPLETED:	02:22 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	This is a change of ownership application. Facility is currently operating. Licensing Program Analyst (LPA) Kim Leung along with Licensing Program Manager (LPM) Stephanie Hudak conducted a prelicensing inspection at the facility this date on 9/7/2021. Upon arrival, LPA and LPM met with applicant Manoj Wickremesinghe and facility director Kaneez Jaffery. LPA and LPM toured the proposed Preschool center, inside and out. The days and hours of operation will be: Monday through Friday from 6:30am to 6:00pm. Measurements of the indoor and outdoor activity space were taken during inspection. Preschool Indoor Activity Areas LPA has determined that there is sufficient space to accommodate 78 children, the requested capacity. Room 3 is for the toddler class and it could accommodate the requested capacity of 12 toddlers. Preschool Bathroom Fixtures 5 toilets x 15 = 75 preschool children 1 toilet x 15 = 15 toddler children 5 sinks x 15 = 75 preschool children 1 sink x 15 = 15 toddler children Preschool Outdoor Activity Area: LPA has determined that there is sufficient space to accommodate 75 children. Applicant has submitted a written request for a waiver for the outdoor activity space by scheduling outdoor activity time by groups. Limiting factor for preschool capacity is outdoor activity space. Preschool capacity is limited to 75 children.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim Leung	TELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: COUNTRYSIDE MONTESSORI ACADEMY	FACILITY NUMBER: 334846059
	VISIT DATE: 09/07/2021

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The following was observed:
· Rooms 1, 2 and 3 are currently used. The classrooms are adequately equipped with age and size appropriate furniture and equipment. Applicant states that sufficient age appropriate furniture will be in place in Room 4 prior to using the room as a regular classroom.
· There are drinking faucets indoor and on playground to supply drinking water. Applicant states that during the COVID-19 pandemic, the facility is providing drinking water by using water bottles, pitchers of water and disposable cups. The bottles are filled up by staff throughout the day.
· 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 at this time. Applicant and director understand that all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· An adequate amount of cushioning material (rubber filler) is in place under play equipment
· Adequate shade is provided on the playgrounds. In addition, there is a patio to provide shade.
· Kitchen is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of snacks. Applicant states that facility does not provide lunch during the COVID-19 pandemic.
· The office area is located at the front and will serve as the isolation area for ill children temporarily until parents arrive
· Staff bathroom will also be used as the isolation bathroom and is conveniently located to the isolation area
· Medications will be stored at in the kitchen
· The applicant states that they do not plan to provide Incidental Medical Services at this time. LPA informed the applicant that prior to providing any incidental medical services that a written plan must be submitted to the licensing office.
· First Aid kit is complete
· Sign in/Sign out record was reviewed and meets regulation requirements
· Component II Orientation was completed during this inspection
· 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

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim Leung	TELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: COUNTRYSIDE MONTESSORI ACADEMY	FACILITY NUMBER: 334846059
	VISIT DATE: 09/07/2021

NARRATIVE

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· A review of staff records on 9/7/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
· The applicant has been informed that all employees must be associated to the facility. If the licensee fails to have proof of a fingerprint clearance or fails to associate a previously cleared individual to the facility, a civil penalty of $100.00, per day the person has been present, will be assessed. The first violation is subject to the penalty for up to five days. If there is a subsequent violation in a 12-month period, the fine will continue for up to 30 days.
· The applicant was advised that 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 be posted for 30 days.

The following was also reviewed and discussed:
This facility does not provides Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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) / (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

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim Leung	TELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: COUNTRYSIDE MONTESSORI ACADEMY	FACILITY NUMBER: 334846059
	VISIT DATE: 09/07/2021

NARRATIVE

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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.
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 Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov
v AB2370 – Lead Exposure, day care facilities, effective January 1, 2019 - An act amending Sections 1596.866 and 1596.8661 and adding Sections 1596.7996 and 1597.16 to the

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim Leung	TELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

Page: 4 of 8

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: COUNTRYSIDE MONTESSORI ACADEMY	FACILITY NUMBER: 334846059
	VISIT DATE: 09/07/2021

NARRATIVE

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Health and Safety Code for the education of risks and effects of lead exposure in child care facilities and for the testing of drinking water in licensed child care centers. Licensed providers have access to a document regarding lead toxicity prevention created in partnership with the California Department of Public Health (CDPH) to provide to parents/guardians of newly enrolled or reenrolled children with information on the following:
· Risks and effects of lead exposure
· Blood lead testing recommendations and requirements
· Options for obtaining blood lead testing, including any programs that offer free or discounted tests
This printable document (Lead Poisoning Facts) is located here as well as on the Child Care Licensing website. The bill also requires that the Department add instruction on the prevention of lead exposure to the Preventative Health and Safety Training curriculum for providers licensed on or after July 1, 2020. Finally, it 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. The Department must adopt regulations in consultation with the State Water Resources Control Board for the implementation of the requirements for the testing of drinking water for lead in Child Care Centers by January 1, 2021. The regulations shall include requirements to ensure the collection and submission of valid water samples.
v AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021 - An act amending Sections 1596.76, 1596.955 and 1596.956 and adding Section 1596.951 to the Health and Safety Code to address requirements for a single license and extend the period for possible participation in the toddler programs. It requires the California Department of Social Services, in consultation with stakeholders, to adopt regulations on or before January 1, 2021, to create a Child Care Center license to serve infant, toddler, preschool, and school-age children. It also requires, before January 1, 2024, that all Child Care Centers transition to one-center licenses. Access to forms & Regulations for Child Care Centers online at www.ccld.ca.gov.

v 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

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim Leung	TELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

Page: 5 of 8

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: COUNTRYSIDE MONTESSORI ACADEMY	FACILITY NUMBER: 334846059
	VISIT DATE: 09/07/2021

NARRATIVE

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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. Further, the bill would require the SSPI to submit a report to the Legislature by January 1, 2021, proposing plans for enhancements to the online portal and inclusive of a comprehensive implementation plan, based on recommendations from the workgroup.

v Access to forms & Regulations for a Child Care Center are online at www.ccld.ca.gov.

v Please 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
v The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).
v - AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – In accordance with California Health and Safety Code Section 1596.8662 – requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. Existing licensees must meet requirements by March 30, 2018. New employees shall have 90 days to complete training as required. This training requirement may be directly met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/ and are provided in English and Spanish. If no training is made available in a required person’s primary language then those persons shall be exempt from this requirement
v AB2370 – Lead Exposure, day care facilities, effective January 1, 2019 - An act amending Sections 1596.866 and 1596.8661 and adding Sections 1596.7996 and 1597.16 to the Health and Safety Code for the education of risks and effects of lead exposure in child care facilities and for the testing of drinking water in licensed child care centers. Licensed providers have access to a document regarding lead toxicity prevention created in partnership with the California Department of Public Health (CDPH) to provide to parents/guardians of newly enrolled or reenrolled children with information on the following:
· Risks and effects of lead exposure
· Blood lead testing recommendations and requirements
· Options for obtaining blood lead testing, including any programs that offer free or discounted tests

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim Leung	TELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

Page: 6 of 8

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: COUNTRYSIDE MONTESSORI ACADEMY	FACILITY NUMBER: 334846059
	VISIT DATE: 09/07/2021

NARRATIVE

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v This printable document (Lead Poisoning Facts) is located here as well as on the Child Care Licensing website. The bill also requires that the Department add instruction on the prevention of lead exposure to the Preventative Health and Safety Training curriculum for providers licensed on or after July 1, 2020. Finally, it 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. The Department must adopt regulations in consultation with the State Water Resources Control Board for the implementation of the requirements for the testing of drinking water for lead in Child Care Centers by January 1, 2021. The regulations shall include requirements to ensure the collection and submission of valid water samples.

An exit interview was conducted and during the interview, the applicant Manoj Wickremesinghe confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

The following items need to be completed/corrected prior to a license being issued:
1. Thoroughly clean and sanitize the furniture, the cabinets, drawers and storage containers for supplies in Rooms 1, 2, 3 and the kitchen.
2. Shampoo the carpet and rugs, clean and sanitize the floor in Rooms 1, 2 and 3.
3. Remove excess items and boxes from the top of the cabinet in Room 3 to prevent injuries in case of Earthquake.
4. Make a First Aid booklet available at the facility.
5. Provide locked boxes for storage of medications.
6. Immunization record against measles from director Kaneez Jaffery.
7. Report of health screening with date and TB test with date from applicant Manoj Wickremesinghe.
8. Certificate of Completion of Child Care Center Orientation - Operations and Record Keeping from director.
9. Waiver to allow shared use of the playgrounds between the preschool children and toddlers.
10. Post up signs at the doors of the restrooms to identify the restroom for the preschool classes and the restroom for the toddler class.
11. Fee schedule
12. Escrow closing statement.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim Leung	TELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

Page: 7 of 8

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: COUNTRYSIDE MONTESSORI ACADEMY	FACILITY NUMBER: 334846059
	VISIT DATE: 09/07/2021

NARRATIVE

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A fire clearance has been obtained. Once all corrections have been made, with proof sent to licensing, and the required documents have been received, the application will be submitted for approval with a maximum capacity of 75 children, ages 2 through kindergarten with a toddler option of 12 children, ages 18 to 36 months. If a waiver is granted on the outdoor activity space, the capacity would be 78 children. 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 provided to the applicant on this date.

COVID-19 RAST (Rapid Assistance Support Team) inspection was conducted this date during the same visit. Self-Assessment on file.

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

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim Leung	TELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

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