364840755-12-9-2021-12-CC-DMAX-C9JLY7-20211209080948

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364840755
Report Date: 11/17/2021
Date Signed: 12/09/2021 08:10:00 AM

Document Has Been Signed on 12/09/2021 08:10 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	FUNDAMENTALS PRESCHOOL ACADEMY, THE		FACILITY NUMBER:	364840755
ADMINISTRATOR:	EVELYN CHINCHILLA		FACILITY TYPE:	840
ADDRESS:	2424 KENDALL DRIVE		TELEPHONE:	(909) 887-1150
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92407
CAPACITY: 61	TOTAL ENROLLED CHILDREN: 61	CENSUS: 0	DATE:	11/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Evelyn		TIME COMPLETED:	03:00 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	Licensing Program Analyst (LPA) Maddox met with Center Director, Evelyn Chinchilla, today for the purpose of conducting an unannounced Annual/Random inspection for the School age program. There were no SA children present during this inspection. Center utilized 1 classroom in the main building and there are additional modulars in the rear of the center designated for SA children. There's a waiver on file for an alternative schedule for the school age children to share the playground with preschool children. This center also has a licensed Infant Component (364841490) and Preschool component (364817412). Each component maintains a physical separation. The hours of operation: Monday through Saturday 6:30AM - 9:00PM. LPA reviewed a sampling of staff and children files as part of this inspection (Names recorded on LIC 859 dated 11/17/21). LPA toured and inspected the classroom designated for the SA program. LPs observed age appropriate furniture, equipment, toys and materials. Telephone service was verified as well as adequate heating, lighting, and ventilation. Children's belongings are kept in cubbies along the wall as you enter classrooms and along the far wall. Drinking water is available inside the classroom in the form of pitchers and disposable cups.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FUNDAMENTALS PRESCHOOL ACADEMY, THE	FACILITY NUMBER: 364840755
	VISIT DATE: 11/17/2021

NARRATIVE

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**The children's bathrooms (2 separate bathrooms, each with 1 toilet and 1 sink) are located in the classroom area.

There is a staff rest-room located in the hallway area, bathroom is marked as Staff Bathroom and also designated as the isolation bathroom. LPA observed the bathrooms to be clean and sanitary, with soap, toilet paper and paper towels readily available. Toilets and sinks are functioning properly and age appropriate

LPA verified there is at least 1 staff person present with current CPR and First Aid training (exp. 3/2022).
*Snack/lunch menus, Allergy list were reviewed and posted. Food and snacks were reviewed for availability, quantity, proper storage, and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. (1 freezer 1 refrigerator, sink, stove/oven).
*Disinfectants, cleaning solutions, poisons and other items that are dangerous or hazardous were inaccessible to children and stored in kitchen locked cabinet.
*All flooring was found to be clean and safe (Director states carpets and floors were cleaned everyday by a contracted cleaning company.

, parent board observed and fire drills are current. Fire extinguisher operable.

*Trash cans/storage containers for solid waste had tight-fitting covers that are kept on, and in good repair.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FUNDAMENTALS PRESCHOOL ACADEMY, THE	FACILITY NUMBER: 364840755
	VISIT DATE: 11/17/2021

NARRATIVE

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*First Aid supplies were inventoried, a review of medication policy, including administering, labeling, and storage. *Telephone service, heating, lighting and ventilation were evaluated.

*Outdoor area and equipment was inspected for safety, cushioning material, good repair and age appropriateness, LPAs noted shade, and drinking water: There are no bodies of water on the premises.

*Isolation area is located in the front office the children get to use the adjacent staff staff bathrooms.

ADMINISTRATION:

*Director is aware that the Department has full inspection authority as specified in Health and Safety Code 1596.852, 1596.853, and 1596.535.

*There were no excluded individuals present; staff present were fingerprint cleared and associated, LPAs and Director reviewed Personnel Report (LIC 500) together during this inspection.

A review of medication policy indicated that prescription medication is administered only with parent's written permission. The Director administers medication and documents the dosage, date and time onto a log. Medication brought and taken home by the parent daily. Medication is properly labeled and stored in its original container.

*Center was found to be operating within its specified ratio and capacity.

*Sign in and Out sheets were inspected.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FUNDAMENTALS PRESCHOOL ACADEMY, THE	FACILITY NUMBER: 364840755
	VISIT DATE: 11/17/2021

NARRATIVE

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A sampling of children’s files was reviewed and contained emergency contact information, staff files were reviewed and contained qualifications.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s personnel, and administrative records. 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 Centers and ADA, available at: http://www.ada.gov/childqanda.htm
***Center has Physical separation for each component (101438.3)
Licensee is advised for quarterly updates to contact the Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in visible location the authorized representatives of children.

Exit interview conducted with Licensee Evelyn Chinchilla. LPA will return to conduct Staff Interviews. LPA printed the Child Safety Seat poster and the form to document Emergency Disaster Drills. Type B citations issued for incomplete staff file.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/09/2021 08:10 AM - It Cannot Be Edited

Created By: Donna Maddox On 11/17/2021 at 01:58 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FUNDAMENTALS PRESCHOOL ACADEMY, THE	FACILITY NUMBER: 364840755
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/17/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(2)

This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on file review, Staff person Ms. Karen is missing a signed copy of her Health Screening
	POC Due Date: 12/08/2021
	Plan of Correction
1 2 3 4	Director shall forward a copy of Ms. Karens most recent Health Screening by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Mariela Ramon

LICENSING EVALUATOR NAME:

Donna Maddox

LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

LIC809 (FAS) - (06/04)

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