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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360910988
Report Date: 08/24/2023
Date Signed: 08/24/2023 06:46:28 PM


Document Has Been Signed on 08/24/2023 06:46 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:YMCA/MARIPOSA ELEMENTARY SCHOOLFACILITY NUMBER:
360910988
ADMINISTRATOR:CATALINA VARELAFACILITY TYPE:
840
ADDRESS:30800 PALO ALTO DRIVETELEPHONE:
(909) 735-6863
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:70CENSUS: 33DATE:
08/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Director Cherie GuerreroTIME COMPLETED:
06:55 PM
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On 08/24/2023 at 3:55 PM Licensing Program Analyst (LPA) Susan Brewer arrived unannounced for the purpose of conducting a required – 1 year inspection. LPA was greeted by Director Cherie Guerrero, toured the school-age center, inside and out. The following was observed:

Days and Hours of Operation: Mon-Fri 2:05 PM to 6:00 PM, Minimum Days: 11:50 AM to 6:00 PM;
The facility follows the school schedule for holiday breaks and summer break.

The inspection consisted of reviews of the following domains: Food Service Reporting Requirements
Physical Plant, Care and Supervision Children Records, Staff Records Staffing Ratio and Capacity
Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809-D. A review of the staff records and children's records were conducted as part of this evaluation. The licensee is asked to update the following documents and submit to licensing within 30 days: Only if changes have been made:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility
6. Lead test results.

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
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023
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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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: YMCA/MARIPOSA ELEMENTARY SCHOOL
FACILITY NUMBER: 360910988
VISIT DATE: 08/24/2023
NARRATIVE
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· The facility is operating within the terms of the license.
· Facility is clean, safe and sanitary and in good repair.
· Ratios were met during this inspection. LPA took a census of 33 children in the care of 3 staff.
· A fully charged fire extinguisher (2A:10BC) was observed. A smoke detector and carbon monoxide detector are hardwired and were present during this inspection.
· Last fire drill on 04/17/2023 at 3:13 PM.
· Appropriate supervision was provided during this inspection.
· Classrooms are equipped with age-appropriate furniture and equipment in good condition.
· Classrooms are clean and free of hazards.
· All materials and surface accessible to children are toxic free
· No weapons stored at the facility.
· There are no bodies of water present on 08/24/2023. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Medications are NOT stored where inaccessible to children.
· Center is equipped to isolate and care for any child who becomes ill during, the child will be placed in an area close to the director and staff restrooms in the multipurpose room will serve as an alternate isolation restroom.
· Hazards are stored where inaccessible to children which include: disinfectants, cleaning solutions and other items that are dangerous to children.
· All floors shall be clean and safe.
· Measures are taken to keep the facility free of flies, other insects, and rodents.
· Toxins are locked.
· 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.
· Food preparation area is clean and free of vermin.
· Food is stored appropriately and protected from contamination in the school kitchen.
· All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Waste containers are marked for YMCA use, separate from school waste containers.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
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: YMCA/MARIPOSA ELEMENTARY SCHOOL
FACILITY NUMBER: 360910988
VISIT DATE: 08/24/2023
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· Uncontaminated drinking water shall be readily available both indoors and out and is provided by bottled water. There is a combination drinking fountain/bottle filling station located outside of the cafeteria, accessible to children.
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall. LPA observed natural grass in the outdoor activity area.
· Menus shall be posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request.
· Sign in/Sign out record was reviewed and meets regulation requirements
· A Staff member is present with current Pediatric CPR/First Aid which expires on 08/06/2024.
· Opening and closing staff member’s CPR/First Aid expires on 08/06/2024.
· Director completed Health, Safety, Nutrition: Spring 2017; Lead on 09/18/2022.
· Staff qualifications and files were reviewed – health screening is NOT on file for 2 of 3 staff, and LPA was unable to verify if subject staff meet educational requirements and health requirements for performing assigned tasks.
· Staff received on the job training for housekeeping, sanitation and universal health precautions
· Each child’s file is complete on 08/24/2023.
· Licensee was informed of the Department has inspection authority per Health and Safety Codes.
· Documentation of Lead Testing is on file: Report provided for 05/20/2023 lead test date, however lead testing results were unavailable for review.
· A review of staff records on 06/01/2023 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 was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: YMCA/MARIPOSA ELEMENTARY SCHOOL
FACILITY NUMBER: 360910988
VISIT DATE: 08/24/2023
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Director Cherie Guerrero, was reminded that all adults 18 and over living or working at the facility, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov for Riverside Regional Office.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.



Deficiencies were cited this visit for Type B violations.

Civil Penalties were not issued this visit.

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

Exit interview conducted and report was reviewed with the Director Cherie Guerrero.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 08/24/2023 06:46 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: YMCA/MARIPOSA ELEMENTARY SCHOOL
FACILITY NUMBER: 360910988

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in1 of 3 staff present and caring for children did not have proof that he or she has not been immunized against influenza, pertussis, and measles, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2023
Plan of Correction
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The licensee agrees to provide proof of immunization records for a subject staff, to include influenza or letter to decline, pertussis, and measles, and submit to the department by fax, mail or e-mail on or before 08/31/2023.
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in 2 of 3 staff present did not have proof of a physical health exam or a LIC503 licensing form completed by a licensed physician, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2023
Plan of Correction
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The licensee agrees to provide proof of physical health exam records or a the LIC503 form completed by a licensed physician, for two subject staff and submit to the department by fax, mail or e-mail on or before 09/25/2023
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 WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023
LIC809 (FAS) - (06/04)
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