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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841606
Report Date: 03/09/2022
Date Signed: 03/09/2022 12:27:38 PM


Document Has Been Signed on 03/09/2022 12:27 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:YUCAIPA CHRISTIAN PRESCHOOLFACILITY NUMBER:
364841606
ADMINISTRATOR:DONALD PATTONFACILITY TYPE:
850
ADDRESS:34968 AVENUE HTELEPHONE:
(909) 797-6814
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:118CENSUS: 50DATE:
03/09/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Director Teresa DohertyTIME COMPLETED:
12:35 PM
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Due to COVID-19, on 03/09/2022, Licensing Program Analyst (LPA) Destinee Hogue conducted a Case Management inspection to provide technical assistance. LPA met with Director, Teresa Doherty, toured the facility, took census, and verified staff associations.

During the inspection, LPA reviewed and discussed COVID-19 guidelines, resources, and postings with Director. COVID-19 information posters including hand-washing posters were observed in child care areas and bathroom. The Director was advised to follow the child care industry guidelines on face coverings, sanitation and other infection prevention measures.

During today’s inspection the following resources were discussed and provided:

· Community Care Licensing Division’s COVID 19 Information and Resources: https://www.cdss.ca.gov/inforesources/community-care-licensing

· CDPH’s Guidance for Child Care Providers and Programs - updated June 29, 2021: www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Child-Care-Guidance.aspx

· Cal-OSHA - revisions are effective starting on January 17, 2022: https://www.dir.ca.gov/dosh/coronavirus/ETS.html

· San Bernardino County Public Health
Tel: (909) 381-8990
Website: http://wp.sbcounty.gov/dph/
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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: YUCAIPA CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364841606
VISIT DATE: 03/09/2022
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§ Child Care Resource Center (CCRC):
Tel: (909) 384-8000
Website: https://www.ccrcca.org/

· To report an Unusual Incident Report (UIR), please fax/scan a completed UIR form (within 24 hours of incident occurring), to the Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov or fax to 951-782-4985.

· FORMS: Unusual Incident Report-LIC624 (Child Care Center) .

· You may also contact the Duty Officer at 951-782-4200

· In addition, Provider Information Notices (PINs) and other resources regarding COVID-19 can be found on our website at: www.cdss.ca.gov

No deficiency was cited during this inspection.

An exit interview was conducted with Director, Teresa Doherty. LPA provided Director with a copy of this report and a Notice of Site Visit which shall remain posted for 30 days.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
LIC809 (FAS) - (06/04)
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