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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360911007
Report Date: 02/28/2024
Date Signed: 02/28/2024 10:49:44 AM


Document Has Been Signed on 02/28/2024 10:49 AM - It Cannot Be Edited

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:FUSD/RANDALL-PEPPERFACILITY NUMBER:
360911007
ADMINISTRATOR:DARCY WHITNEYFACILITY TYPE:
850
ADDRESS:16613 RANDALL AVE.TELEPHONE:
(909) 357-5739
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:24CENSUS: 12DATE:
02/28/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Dinora Quintana, Lead TeacherTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analysts (LPA), Aman Sharma conducted a required annual inspection. LPA was met with lead teacher in classroom K-1, Dinora Quintana. LPA toured both, inside and outside, and the following was observed and/or noted:
The following documents are requested to be updated, as needed and submit to the Riverside Regional Office (RRO) within 30 days of this report:
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
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
- Food menu.
· The facility is operating with the limits as stated on the license.
· Ratios were met during this inspection.
· Classrooms are adequately equipped with age and size appropriate furniture and free of hazards.
· There are no weapons present at the facility.
· 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.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024
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: FUSD/RANDALL-PEPPER
FACILITY NUMBER: 360911007
VISIT DATE: 02/28/2024
NARRATIVE
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· Children bring their own water bottles for drinking water, and refill as needed from an uncontaminated drinking fixture inside the classroom.
· Hazards are stored where they were accessible to children. These include: Disinfectants, cleaning solutions and other items that are dangerous to the health and safety of children in care.
· Poisons and toxins are kept locked and inaccessible to children, per Title 22 Regulations.
· All floors were observed clean and safe and shall remain so at all times.
· Restrooms were observed to be sanitary and in operating condition-SEE LIC9102.
· Playgrounds are enclosed by appropriate fences.
· Outdoor activity areas are in good condition and supplied with age/size appropriate equipment.
· The areas around or under high climbing equipment, swings, slides, and similar equipment were cushioned with material that absorbs a fall. There is a piece of cushion missing on the left most slide of the climbing structure-SEE LIC809D
· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin.
· Food is stored appropriately and protected from contamination.
· Menus were posted with date included and were placed in a visible location of children’s authorized representatives. Menus shall be kept on file for 30 days, and made available upon request.
· All storage containers for solid waste, including moveable bins have tight-fitting covers that were observed to be on and in good repair.
· Sign in/Sign out record was reviewed and meets regulation requirements.
· Closing/opening staff present had a current CPR/First Aid on file.
· A review of children’s records were found to be incomplete during this inspection-SEE LIC809D.
· Disaster drills are to be conducted every six months – last drill was conducted on 01/23/24.
· The facility is 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 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 facility can submit transfer forms to associate or disassociate someone from their facility at: Associations_Disassociations862@dss.ca.gov
· A review of staff records indicates that staff that were present meet minimum qualifications for the position for which they were hired.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
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: FUSD/RANDALL-PEPPER
FACILITY NUMBER: 360911007
VISIT DATE: 02/28/2024
NARRATIVE
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- This facility is not currently providing Incidental Medical Services (IMS). LPA discussed children’s, personnel, and administrative records to be completed, as needed. 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

- The facility was reminded that all adults 18 and over, 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 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.

- 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 Provider Information Notices (PIN) for.

- 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: 951-782-4200



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.

LPA conducted the exit interview and reviewed report with lead teacher, Dinora Quintana.

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

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 02/28/2024 10:49 AM - 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: FUSD/RANDALL-PEPPER
FACILITY NUMBER: 360911007

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(1)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the facility did not comply with the section cited above. There is a missing piece on the cushion flooring in front of the left slide on the climbing structure outside. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/27/2024
Plan of Correction
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Facility agrees to show proof of a work order and replacement of cushion no later than the POC due date.
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above in 1 out of 6 children. C6 did not have an updated physicians report on file. C6 has one on file from 2022, but not for the new school year. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/27/2024
Plan of Correction
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Facility agrees to submit proof of an updated physicians report for C6 no later than the POC due date.
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) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024
LIC809 (FAS) - (06/04)
Page: 4 of 10


Document Has Been Signed on 02/28/2024 10:49 AM - 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: FUSD/RANDALL-PEPPER
FACILITY NUMBER: 360911007

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above in 2 out of 6 children. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2024
Plan of Correction
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Facility agrees to get LIC627 completed by parent/authorized representative of C4 and C6 and submit to licensing no later than the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024
LIC809 (FAS) - (06/04)
Page: 5 of 10