364841730-5-27-2021-09-CC-JGIE-C3EPLR-20210527112509

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364841730
Report Date: 05/26/2021
Date Signed: 05/27/2021 11:25:27 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:	NOAH'S ARK 4 KIDS CHILD CARE CENTER		FACILITY NUMBER:	364841730
ADMINISTRATOR:	MURPHY, TAMMY		FACILITY TYPE:	840
ADDRESS:	27061 BASELINE		TELEPHONE:	(951) 662-0943
CITY:	HIGHLAND	STATE: CA	ZIP CODE:	92346
CAPACITY:	10	CENSUS: 7	DATE:	05/26/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Tammy Murphy		TIME COMPLETED:	11:45 AM

NARRATIVE

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On 5/27/2021 at 10:30am Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the facility to conclude an issue previously discussed on 5/11/2021. This Case Management inspection is being conducted to address a separate issue that was discovered while gathering information during an investigating.

After departure from the facility inspection on 05/11/2021, LPA observed day care children and school aged children commingling in the outdoor playground area.

The facility was found to be in violation of the following Title 22 regulation:

101538.2(b)Outdoor Activity Space for School-Age Children: In combination programs, outdoor activity space provided for school-age childcare center children shall be physically separated from space provided for other child care center children.

See LIC 809-D for cited Type B deficiency

LPA provided the Director a Technical Violation (TV) and provided technical guidance regarding Reporting Requirements. The following regulation was discussed:

101212(d)(1)(B) Reporting Requirements (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report... shall be submitted to the Department within seven days following the occurrence of such event.

(1) Events reported shall include the following:
(B) Any injury to any child that requires medical treatment.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin Giese	TELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: NOAH'S ARK 4 KIDS CHILD CARE CENTER	FACILITY NUMBER: 364841730
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/26/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/10/2021 Section Cited	1 2 3 4 5 6 7	Outdoor Activity Space for School-Age Children. In combination programs, outdoor activity space provided for school-age child care center children shall be physically separated from space provided for other child care center children. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on LPA's observation, after departure from the facility inspection on 05/11/2021, LPA observed day care children and school aged children comingling in the outdoor playground area. This poses a potential health and safety risk to the 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: Gilbert Sena	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin Giese	TELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: NOAH'S ARK 4 KIDS CHILD CARE CENTER	FACILITY NUMBER: 364841730
	VISIT DATE: 05/26/2021

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LPA's observation and interviews pertaining to a separate inspection/investigation disclosed unreported incidents where children sustained minor injuries requiring first aide. Although the facility staff acted in the best interest of the children by administering first aide and verbally communicated such occurrences with Parent/guardians, the facility did not meet their reporting requirements by informing Licensing and submitting a LIC624, Unusual Incident Report.

The Facility Director acknowledges and understands the importance of this regulation pertaining to reporting requirements. Director agrees to contact Licensing within 24 hours of incident and submit written report on LIC624 within seven days following the occurrence of such event.

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.

A copy of this report was provided to the licensee on this date and must be made available to the public upon request for the next 3 years.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin Giese	TELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

LIC809 (FAS) - (06/04)

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