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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300393
Report Date: 09/30/2021
Date Signed: 09/30/2021 02:38:44 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:SUNNYMEADOWS ELEMENTARY PRESCHOOLFACILITY NUMBER:
336300393
ADMINISTRATOR:ADCOCK, JENNIFERFACILITY TYPE:
850
ADDRESS:23200 EUCALYPTUS AVETELEPHONE:
(951) 571-4716
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:30CENSUS: 0DATE:
09/30/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Jennifer Adcock & Star MonvilleTIME COMPLETED:
02:50 PM
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Licensing Program Analysts (LPAs), Joanne Domingo and James Wilkerson, toured proposed Preschool center, inside and out. LPAs conducted COVID-19 Screening question prior to entry. A Fire Clearance was received and approved on 8/03/21. The days and hours of operation will be: MONDAY - FRIDAY FROM 8:30AM - 11:30AM AND 12:30PM - 3:30PM FOR CHILDREN AGES 3 - 5 YEARS OLD. The following measurements were taken:

Preschool Indoor Activity Areas
LPA has determined that there is sufficient space to accommodate 30 children.

Preschool Bathroom Fixtures
2 toilets x 15 = 30 children
3 sinks x 15 = 45 children

Preschool Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 30 children.

Limiting factor for preschool capacity is 30. Preschool capacity is limited to 30 children.

The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment YES
· PUBLIC supply drinking water in the indoor activity space FACILITY TO PROVIDE ADDITIONAL CUPS AND WATER PITCHERS. PARENTS TO SUPPLY INDIVIDUAL DRINKING BOTTLES.
· Playgrounds are enclosed by appropriate fences YES
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: SUNNYMEADOWS ELEMENTARY PRESCHOOL
FACILITY NUMBER: 336300393
VISIT DATE: 09/30/2021
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· Outdoor activity areas are supplied with age and size appropriate equipment YES
· 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. NONE OBSERVED DURING THIS VISIT.
· An adequate amount of cushioning material WOOD CHIPS is in place under play equipment
· Adequate shade is provided YES
· Drinking water is provided in the outdoor play areas by FACILITY TO PROVIDE ADDITIONAL CUPS AND WATER PITCHERS. PARENTS TO SUPPLY INDIVIDUAL DRINKING BOTTLES.
· Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies YES
· The office area is located IN REAR OF CLASSROOM 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 YES
· Toxins are locked YES
· Medication will be stored IN KITCHEN ABOVE FRIDGE and will be secured in a locked BOX.
· The Licensee states that they aret 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. YES
· Medication administration forms were reviewed YES
· First Aid kit is complete YES
· Sign in/Sign out record was reviewed and meets regulation requirements YES
· Component II Orientation was completed during this inspection JA-2/19/15 AND SM-8/30/21
· A review of staff records on 9/29/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. YES
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: SUNNYMEADOWS ELEMENTARY PRESCHOOL
FACILITY NUMBER: 336300393
VISIT DATE: 09/30/2021
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· 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 Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations858@dss.ca.gov
· 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.
· Applicant know 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
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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: SUNNYMEADOWS ELEMENTARY PRESCHOOL
FACILITY NUMBER: 336300393
VISIT DATE: 09/30/2021
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The following was also reviewed and discussed:
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. This training is free of cost and available at: 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
This printable document (Lead Poisoning Facts) is located here as well as on the Child Care Licensing website. The bill also requires that 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.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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: SUNNYMEADOWS ELEMENTARY PRESCHOOL
FACILITY NUMBER: 336300393
VISIT DATE: 09/30/2021
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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 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, Title 22 Regulations and Provider Information Notices (PINS) for a Child Care Center are online at www.ccld.ca.gov.



v Please subscribe at www.childcareadvocatesprogram@dss.ca.gov 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).
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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: SUNNYMEADOWS ELEMENTARY PRESCHOOL
FACILITY NUMBER: 336300393
VISIT DATE: 09/30/2021
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v The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov

An exit interview was conducted and during the interview, the licensee, JENNIFER ADCOCK 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. Waivers for shared outdoor playground and consolidated billing pending.

Once all corrections have been made, with proof sent to licensing, and the fire clearance has been obtained, The application will be submitted for approval with a maximum capacity of 30. 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.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
LIC809 (FAS) - (06/04)
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