364810037-10-31-2019-09-CC-TZER-BHGM7R-20191031092158

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364810037
Report Date: 10/10/2019
Date Signed: 10/31/2019 09:22:19 AM

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:	SBCUSD-URBITA PRESCHOOL		FACILITY NUMBER:	364810037
ADMINISTRATOR:	KELLY, LATASHIA		FACILITY TYPE:	850
ADDRESS:	771 S. J STREET		TELEPHONE:	(909) 388-6488
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92410
CAPACITY:	23	CENSUS: 17	DATE:	10/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Sarah Glass		TIME COMPLETED:	01:30 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	(1) A random annual inspection is being conducted as part of a compliance review. Licensing Program Analyst (LPA), Taadhimeka Zeigler, toured the center, inside and out. The following was observed: • A review of the staff records and review of a sampling of children's records were conducted as part of this evaluation. • 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 · The facility is operating within the terms of the license · Ratios were met during this inspection · 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 · No weapons stored at the facility There are no accessible bodies of water present.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka Zeigler	TELEPHONE: (951) 680-6745
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

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 4

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: SBCUSD-URBITA PRESCHOOL	FACILITY NUMBER: 364810037
	VISIT DATE: 10/10/2019

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
26
27
28
29
30
31
32

· Medications and hazards are stored where inaccessible to children
· Poisons and toxins are locked
· All floors shall be clean and safe
· Bathrooms were observed to be safe, sanitary and in operating condition
· Playgrounds are enclosed by appropriate fences. The playground apparatus was observed to have an excess of spider webs
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition
· Uncontaminated drinking water is available inside and outside
· 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 07/17/2020
· Director completed Health and Safety Training on 05/1998
· Required records for staff shall ensure that each personnel record contain a health screening
· Documentation of fire & earthquake drills to be conducted every six months

This facility provides Incidental Medical Services – IMS.

The following was also reviewed and discussed:
SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016
AB290-Child Nutrition, effective January 1, 2016
SB792-Immunizations, Personal Beliefs Exemption, effective 01/01/2016
AB2231 (2016)-Increased Civil Penalties, effective July 1, 2017
AB1207-Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning 01/01/2018
AB2370-Lead Exposure, day care facilities, effective 01/01/2019

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

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka Zeigler	TELEPHONE: (951) 680-6745
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: SBCUSD-URBITA PRESCHOOL	FACILITY NUMBER: 364810037
	VISIT DATE: 10/10/2019

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
26
27
28
29
30
31
32

The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.

An exit interview was conducted with Program Specialist, Sarah Glass. Appeal Rights were discussed/issued and a copy of this report was left.

This report must be available for review, upon request, for the next 3 years.

This is an electronic version of a manual report. Original signatures on file.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka Zeigler	TELEPHONE: (951) 680-6745
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: SBCUSD-URBITA PRESCHOOL	FACILITY NUMBER: 364810037
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/10/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/17/2019 Section Cited	1 2 3 4 5 6 7	Buildings and Grounds The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. The licensee shall take measures to keep the center free of flies, other insects, and rodents.
	8 9 10 11 12 13 14	This requirment has not been met as evidenced by: During the observation of the playground, LPA Zeigler observed several areas of the underside of the playground apparatus that contained spiderwebs. This poses a risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka Zeigler	TELEPHONE: (951) 680-6745
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

LIC809 (FAS) - (06/04)

Page: 4 of 4