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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840169
Report Date: 10/11/2023
Date Signed: 10/11/2023 03:44:44 PM


Document Has Been Signed on 10/11/2023 03:44 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:EASTER SEALS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
364840169
ADMINISTRATOR:REGINA HERBERTSONFACILITY TYPE:
850
ADDRESS:9950 MONTE VISTATELEPHONE:
(909) 626-1700
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:105CENSUS: 36DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Regina Herbertson TIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analysts (LPA), Aman Sharma conducted a required annual inspection. LPA was met with site director, Regina Herbertson. An inside out tour of the facility was given, and the following was observed and/or noted:
A review of staff and children's records were reviewed as part of this evaluation.
· The director is asked to update the following documents, if applicable, and submit to licensing within 30 days:
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. LIC200A, application with any changes to hours

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.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: EASTER SEALS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 364840169
VISIT DATE: 10/11/2023
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·Classrooms are adequately equipped with age and size appropriate furniture and equipment and are 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.
· Children are provided filtered water with cups in both, indoor and outdoor activity spaces.
· Uncontaminated drinking water was observed and is used to refill igloo containers kept in each classroom, as needed
· Medications are being used at the facility, LPA checked storage of medications during inspection.
· Hazards are also stored where they were inaccessible to children. These include: Disinfectants, cleaning solutions and other items that are dangerous to the health and safety of children in care. -SEE LIC9102
· Poisons and toxins are locked.
· All floors were observed clean and safe and shall remain so at all times.
· Restrooms were observed to be, sanitary and in operating condition
· 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.
· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin
· Food is stored appropriately and protected from contamination
· All storage containers for solid waste, including moveable bins have tight-fitting covers that were observed to be on and in good repair.
· 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.
· Sign in/Sign out record was reviewed and meets regulation requirements.
· All staff members present had a current Pediatric CPR/First Aid card on file.
· Director completed Health and Safety Training, which is on file.
· A review of children’s records were found to be complete during this inspection.
· Disaster drills are to be conducted every six months – last drill was conducted on 09/26/23
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: EASTER SEALS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 364840169
VISIT DATE: 10/11/2023
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·The Director was 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 Director 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.
- This facility does provide Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records which were 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

- Director 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:


1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200
Exit interview conducted and report was reviewed with the site director, Regina Herbertson.

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

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

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/11/2023 03:44 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: EASTER SEALS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 364840169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023

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 facility did not comply with the section cited above in 1 out of 5 persons. There was no measles for S5 on file. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2023
Plan of Correction
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Director agrees to submit proof of measles for S5 to the department no later than the POC due date.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

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 5. S1 did not have a tuberculosis (TB) on file. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2023
Plan of Correction
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Director agrees to submit proof of TB for S1 to the department 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: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5