364804997-5-4-2023-09-CC-SBRR-CRJ32K-20230504175204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364804997
Report Date: 05/04/2023
Date Signed: 05/04/2023 05:52:23 PM

Document Has Been Signed on 05/04/2023 05:52 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 KIMBERLY SCHOOL-AGE SITE		FACILITY NUMBER:	364804997
ADMINISTRATOR:	NOEMI PURVIS		FACILITY TYPE:	840
ADDRESS:	301 W. SOUTH AVENUE		TELEPHONE:	(909) 735-6845
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92373
CAPACITY:	60	CENSUS: 45	DATE:	05/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Director Kristina Tolento		TIME COMPLETED:	06:00 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	On 05/04/2023 at 12:50 PM A required – 1 year inspection is being conducted as part of a compliance review. Licensing Program Analyst (LPA) Susan Brewer, was greeted by Director Kristina Tolento and granted entry to tour the school-age center, inside and out. The following was discussed and/or observed: Program Coordinator Deidra Gregory arrived at 3:15 PM and joined the inspection. 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 on or before 06/04/2023: Only if changes have been made: 1. LIC 500 Personnel Report – for changes 2. LIC 610 Emergency & Disaster Plan – for changes 3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made) 4. LIC 309 Administrative Organization – for changes 5. LIC 308 Designation of Administrative Responsibility 6. Director’s packet for Kristina Tolento 7. LIC999 Facility Sketch for indoor and outdoor, with changes · 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 Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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 KIMBERLY SCHOOL-AGE SITE	FACILITY NUMBER: 364804997
	VISIT DATE: 05/04/2023

NARRATIVE

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· The facility is operating within the terms of the license on 05/04/2023.
· Facility is clean, safe and sanitary and in good repair.
· Ratios were met during this inspection. A census was taken of 45 children in care.
· Appropriate supervision was provided during this inspection on 05/04/2023.
· Classrooms are equipped with age appropriate furniture and equipment in good condition
· Classrooms are clean and free of hazards, the facility no longer uses classrooms and only uses multi-purpose room for indoor activity space.
· All materials and surface accessible to children are toxic free on 05/04/2023
· No weapons stored at the facility on 05/04/2023.
· There are no bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· No Medications are stored at this time, Incidental Medical Services are not provided to children,
· Center is equipped to isolate and care for any child who becomes ill during the day and use of Staff Restroom #1, and the office if children need to nap when ill and waiting for parent to pick up.
· 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 on 05/04/2023.
· Bathrooms were observed to be safe, sanitary and in operating condition, located in Section 3 bldg.
· Playgrounds are enclosed by appropriate fences and free of hazards.
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition on 05/04/2023.
· Food preparation area is clean and free of vermin.
· Food is stored appropriately and protected from contamination in the Cafeteria Kitchen and is pre-packaged. The only beverage provided is small carton of milk.
· All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. On 05/04/2023, LPA S.Brewer, observed all trash cans to be uncovered. Per Program Coordinator Deidra Gregory, they have discussed the matter with he school site, since the trash cans are provided by the district and the program utilizes the Multi-Purpose Cafeteria room for the after school programming.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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 KIMBERLY SCHOOL-AGE SITE	FACILITY NUMBER: 364804997
	VISIT DATE: 05/04/2023

NARRATIVE

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· Uncontaminated drinking water shall be readily available both indoors and out and is provided by Water fountains.
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall with wood chips, sand and grass.
· 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 02/2025
· Opening and closing staff member’s CPR/First Aid expires on 02/2025
· Director completed Health and Safety Training on 10/07/2021
· Staff qualifications and files were reviewed – health screening is on file and 1 of 4 staff present did not meet educational requirements and health requirements for performing assigned tasks due to missing the TB Screening, and all staff were missing the LIC501 Personnel form or other form for employment.
· Staff received on the job training for housekeeping and sanitation and universal health precautions
· Each child’s file is complete on 05/04/2023.
· Licensee was informed of the Department has inspection authority per Health and Safety Codes
· Documentation of Lead Testing is on file: NOT COMPLETED
· A review of staff records on 05/02/2023 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 Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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 KIMBERLY SCHOOL-AGE SITE	FACILITY NUMBER: 364804997
	VISIT DATE: 05/04/2023

NARRATIVE

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The Facility representative was reminded that all adults 18 and over working in the center, 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.

See LIC809D Type B deficiencies cited this visit.

Civil Penalties 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 licensee Director Kristina Tolento.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/04/2023 05:52 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 KIMBERLY SCHOOL-AGE SITE	FACILITY NUMBER: 364804997
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in the licensee failed to have its drinking water tested for lead contamination levels on by January 1, 2023 and LPA observed two areas of drinking fountains used by daycare children, located oustide of the multi-purpose room and Building 3, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/05/2023
	Plan of Correction
1 2 3 4	The licensee agrees to have its drinking water tested for lead contamination levels on or before June 5, 2023, and every five years after the date of the initial test. Per director Kristina Tolento, the facility will submit proof of lead testing scheduled to the department along with the lead testing forms, list of water outlets for food preparation and/or consumption and facility sketches showing the location of water outlets. Proof of documentation can be submitted by fax, mail or e-mail.

Type B

Section Cited

CCR

101216(g)(2)(B)

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: (B) The presence of any health condition that would create a hazard to the person, children or other staff members. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 of 4 staff present and caring for children did not have proof of a TB screening on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/05/2023
	Plan of Correction
1 2 3 4	The licensee agrees to submit proof of a TB Screening for the subject staff, on or before 06/05/2023. The licensee can submit documentation by fax, mail or e-mail.

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 Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC809 (FAS) - (06/04)

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