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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843934
Report Date: 09/18/2019
Date Signed: 09/18/2019 04:07:35 PM

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:GOOD SHEPHERD CHRISTIAN PRESCHOOLFACILITY NUMBER:
364843934
ADMINISTRATOR:SARAH PARKFACILITY TYPE:
850
ADDRESS:2600 GRAND AVENUETELEPHONE:
(909) 591-6501
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY:90CENSUS: 71DATE:
09/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sarah ParkTIME COMPLETED:
04:12 PM
NARRATIVE
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(2) A random annual inspection is being conducted as part of a compliance review. Licensing Program Analyst (LPA) Kim Leung toured the center, inside and out. The following was observed:
· A review of the staff records and a review of a sampling of children's records were conducted as part of this evaluation.
· The licensee 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 (only if changes have been made)
· 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 except for that in Room 102, LPA observed a child in the restroom was unattended while the only staff member of the class was arranging napping cots in the classroom.
· Classrooms are equipped with age appropriate furniture and equipment in good condition
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019
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: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2019
Section Cited

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Responsibility for Providing Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation. This requirement was not met as evidenced by: In Room 102, LPA observed a child in the restroom was unattended while the only teacher in the
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class was arranging napping cots in the classroom. That presented potential risks to the child's health and safety.
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Type B
09/19/2019
Section Cited

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Buildings and Grounds. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement was not met as evidenced by: LPA observed heavy duty tape cutter, roll of plastic bags with warning label "Keep out of Reach of
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Children", garbage bags and roll of transparent synthetic thread with warning label "Choking Hazard" are stored in unlatched/unlocked drawers, floor cabinets or on top of the sink where accessible to children. That presented potential risks to the children's safety.
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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: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2019
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: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/25/2019
Section Cited

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AB1207. On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...This requirement was not met as evidenced by:
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Proof of training for 4 of the staff members were not available for review during inspection. Director stated that no additional records were available for review at the time. That presented potential risks to the children's safety.
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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: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2019
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: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934
VISIT DATE: 09/18/2019
NARRATIVE
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· All floors are be kept clean and safe
· No weapons stored at the facility as stated by facility director Sarah Park
· There are no accessible bodies of water present at this time. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Medications are stored in the office where inaccessible to children. 3 bottles of over-the-counter medications stored for children are without any written parental consents or instructions.
· Hazards including heavy duty tape cutter, roll of plastic bags with warning label "Keep out of Reach of Children", garbage bags and roll of transparent synthetic thread with warning label "Choking Hazard" are stored in unlatched/unlocked drawers, floor cabinets or on top of the sink where accessible to children.
· Restrooms were observed to be safe, sanitary and in operating condition
· Playgrounds are enclosed by appropriate fences and free of hazards
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition
· 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 covers that are kept on
· Drinking water is readily available by use of water bottles and igloos
· The areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with sand that absorbs falls
· Electronic sign in and sign out
· A Staff member is present with current Pediatric CPR/First Aid which expires on 1/25/2021
· Opening and closing staff member’s CPR/First Aid expires on 1/25/2021 (director who opens and closes)
· Documentation of fire & earthquake drills was reviewed. The most recent drill was conducted on 8/27/2019 per drill log and staff.
· A review of staff records on 9/18/2019 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
· Facility is not currently providing IMS Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. Prior to any IMS is provided an updated Plan of Operation that includes IMS must be submitted to the Department. 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
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2019
Section Cited

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Health Related Services. For each nonprescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative ...When no longer needed by the child, or when the child withdraws from the center, all medications shall be returned to the child's authorized representative or
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disposed of after an attempt to reach the authorized representative. This requirement was not met as evidenced by: 3 bottles of over-the-counter medications stored for children are without any written parental consents or instructions. That presented potential risks to the children's health and safety.
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Type B
09/19/2019
Section Cited

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Child's Records. Each record shall climited to...A signed consent form for emergency medical treatment unless the child's authorized representative has signed the statement specified in Section 101220(f). This requirement was not met as evidenced by: A review of a sample of 6 children's
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records revealed that written consent for emergency medical treatment or declination statement for 4 of the children were not available for review. Director stated that no other records were available for review at the time. That presented potential risks to the children's health and safety in case of emergency.
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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: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2019
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934
VISIT DATE: 09/18/2019
NARRATIVE
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· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Rick-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

See LIC 809D for deficiencies cited.

The following was also reviewed and discussed:
v AB 2621 – Public Information effective January 1, 2015 – The Department shall post licensing reports for Child Care Facilities on it’s internet Web site. This information is to be updated at least monthly on the website and will span the preceding five-year period.
v AB 2236 – Civil Penalties, effective July 1, 2015 – Enacts new civil penalties in cases where the Department determines that a violation of licensing standards resulted in the death or serious injury, or constitutes physical abuse of a child in care. The bill establishes an appeal procedure specific to these civil penalties. The bill also expands the scope of the Child Health and Safety Fund in order to assist parents in securing alternative child care when a Child Care Center license has been suspended or revoked. These civil penalty amounts are scaled in relation to the total capacity of all of the licensee’s facilities and not just the specific facility cited or limited to that facility type.
v AB 2386 – Carbon Monoxide Detector Regulations, effective January 1, 2015 – In accordance with California Health and Safety Code Section 1975.543 - Every child care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections
v - SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 - it eliminates the exemption from existing specified immunization requirements based upon personal beliefs, and only allows an exemption from future immunization requirements deemed appropriate by the State Department of Public Health or a medical professional for medical reasons.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934
VISIT DATE: 09/18/2019
NARRATIVE
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v - AB290 – Child Nutrition, effective January 1, 2016 - In accordance with California Health and Safety Code Section 1596.866 - each child care center shall have at least one person employed who was completed one hour of childhood nutrition training as part of the preventive health practices course or courses.
v - SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 1596.7995(a)(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. If employees/volunteers are receiving the influenza vaccination they must do so between August 1 and December 1 of each year.
v - AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017 – For failing to correct a violation the civil penalty is increased to $100 per day for EACH violation until corrected; For failing to correct a repeated violation the civil penalty is increased to $250 immediately assessed , and $100 per day afterwards for EACH repeated violation until corrected; For a Zero Tolerance violation the civil penalty is increased to $500 immediately assess, and $100 per day for EACH violation after that until corrected; For any repeated Zero Tolerance violation the civil penalty is increased to $1,000 immediately assess, and $100 per day afterwards for EACH repeated violation until corrected.
v NOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.
v Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov
v Access to forms & Regulations for a Child Care Center are online at www.ccld.ca.gov.
v Please subscribe at www.childcareadvocatesprogram@dss.ca.gov to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov
v The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).
v - AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – In accordance with California Health and Safety Code Section 1596.8662 – requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. Existing licensees must meet requirements by March 30, 2018. New employees shall have 90 days to complete training as required. This training requirement may be directly met by using the Department’s Office
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934
VISIT DATE: 09/18/2019
NARRATIVE
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of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/ and are provided in English and Spanish. If no training is made available in a required person’s primary language then those persons shall be exempt from this requirement

During inspection, licensee was advised to visit the following websites for information and guidance on safe sleep practices:
https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
https://safetosleep.nichd.nih.gov/materials

An exit interview was conducted and during the interview, Ms. Park confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

A NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS. Appeal rights were provide and discussed. This report must be available for review, upon request, for the next 3 years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019
LIC809 (FAS) - (06/04)
Page: 8 of 8