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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843934
Report Date: 05/08/2025
Date Signed: 05/08/2025 12:47:54 PM

Document Has Been Signed on 05/08/2025 12:47 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GOOD SHEPHERD CHRISTIAN PRESCHOOLFACILITY NUMBER:
364843934
ADMINISTRATOR/
DIRECTOR:		JUDY PAKFACILITY TYPE:
850
ADDRESS:2600 GRAND AVENUETELEPHONE:
(909) 591-6501
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 34DATE:
05/08/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:13 AM
MET WITH:Yahaira MartinezTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On date and time listed above, Licensing Program Analyst (LPA) Chase Atherton arrived at the facility to conduct a 3-year annual inspection. LPA was granted entry by Director Yahaira Martinez. LPA toured the facility inside and out, reviewed records and observed and/or discussed the following.

Days and hours of operation are Monday -Friday; 7:00 AM- 6:00 PM.
The inspection consisted of reviews of the CARE tool domains. The inspection found the facility to be in compliance except as noted on the LIC809D. Deficiencies were cited this visit.

If updates are made, the Licensee will submit the following documents 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 4. LIC 309 Administrative Organization and 5. LIC 308 Designation of Administrative Responsibility

The following items have been posted and are updated where necessary: License; Emergency Disaster Plan (LIC610); Facility sketch; Earthquake Preparedness Checklist (LIC9148; Parent’s Rights Poster (PUB393); Personal Rights (LIC613A); Child Car Seat Law, and Menu

The facility is operating within the terms of the license with appropriate ratios and supervision during this inspection. Classrooms and floors are clean, free of hazards and rooms are equipped with age appropriate furniture.
No weapons stored 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

Ana NobleTELEPHONE:
Chase AthertonTELEPHONE:
DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/08/2025 12:47 PM - It Cannot Be Edited


Created By: Chase Atherton On 05/08/2025 at 11:29 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview with the facility represetative Yahaira Martinez, the licensee did not comply with the section cited above in that they could not determine the location of the carbon monoxide detector for the LPA to test, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/09/2025
Plan of Correction
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Facility will submit proof (video) of a previously installed carbon monoxide detector cycling through a test alarm. If the previous item cannot be submitted then the facility will purchase a carbon monoxide detector and have it installed at the facility. A copy of the purchase receipt and a photo of the installed carbon monoxide detector, will be submitted to the Department by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/08/2025 12:47 PM - It Cannot Be Edited


Created By: Chase Atherton On 05/08/2025 at 11:29 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(g)(1)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. (1) Storage areas for poisons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that there were items with labels that stated to call poison control if ingested, including "lysol" spray, "off" bug spray, and "raid" bug poison. LPA observed these items stored out of the reach of children, but not stored behind a lock, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2025
Plan of Correction
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Facility will submit proof (pictures) of all items listed above stored in a location secured by a key lock or combination lock. These pictures will be submitted to the Department by the POC due date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in that Staff 1 (S1), S2, & S5 did not have proof of updated Mandated Reporter Training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2025
Plan of Correction
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Facility will submit proof (copies) of all documents listed above to the Department by 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.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/08/2025 12:47 PM - It Cannot Be Edited


Created By: Chase Atherton On 05/08/2025 at 11:29 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review: Staff 1 (S1), S2, & S3 did not have a signed LIC9052 form, S1 & S3 did not have LIC503 form available to review, and S2 did not have a signed LIC501 form available to review, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2025
Plan of Correction
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Facility will submit proof (copies) of all documents listed above to the Department by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2025


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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934
VISIT DATE: 05/08/2025
NARRATIVE
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Medications are stored inaccessible to children in the Director's office.
Hazards and other items that are dangerous are stored inaccessible to children and poisons and toxins are NOT locked. SEE LIC809D for deficiency cited. Bathrooms were observed to be safe, sanitary and in operating condition.

Outdoor activity areas are enclosed by appropriate fences, free of hazards and supplied with age and size equipment in good condition.
Food preparation area is clean, free of litter, and vermin. Measures are taken to keep the facility free of flies, other insects, and rodents. Food is stored appropriately and protected from contamination.
Storage containers for solid waste have tight-fitting covers in good repair.
Uncontaminated drinking water is readily available both indoors and outdoors: water facets.
Areas around or under high climbing equipment have material that absorbs a fall: rubber matting
Sign in/Sign out record was reviewed and meets regulation requirements: Electronic and paper sign in/out
Carbon monoxide detector could not be located during this visit. Follow up needed. SEE LIC809D for deficiency cited.

Menus are current, posted and visible for authorized representatives and available upon request.
A Staff member is present with current Pediatric CPR/First Aid which expires on 7/2025
Opening and closing staff member’s CPR/First Aid expires on 7/2025
Staff have received on-the-job training for housekeeping, sanitation and universal health precautions.
Children files are complete.
Staff files were reviewed and are NOT complete: SEE LIC809D for deficiency cited.
Fire & earthquake drills are conducted and documented every six months.Last drill on 4/14/2025
Facility Representative was informed the Department has inspection authority per Health and Safety Codes.
Facility was provided the Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov

To receive important licensed -related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
SUPERVISOR'S NAME: Ana NobleTELEPHONE:
LICENSING EVALUATOR NAME: Chase AthertonTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934
VISIT DATE: 05/08/2025
NARRATIVE
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MyChildCarePlan.org – Centers and Family Child Care Homes facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.
- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – 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.

- CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5 -years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).
- LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. PIN 22-05-CCP Page Four. LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

- AB2960 – Childcare and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.
- Access to forms & Regulations for Child Care Centers online at www.ccld.ca.gov
- Responsibility to know the regulations for anyone providing care
- Failure to meet the posting requirements shall result in an immediate civil penalty.
- Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/
SUPERVISOR'S NAME: Ana NobleTELEPHONE:
LICENSING EVALUATOR NAME: Chase AthertonTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GOOD SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364843934
VISIT DATE: 05/08/2025
NARRATIVE
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA Atherton informed Facility Representative Yahaira Martinez that this report dated 5/8/2025 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Atherton informed the Facility Representative Yahaira Martinez to provide a copy of this licensing report dated 5/8/2025 that documents any Type A citation(s) to parents of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility Representative, Yahaira Martinez.
SUPERVISOR'S NAME: Ana NobleTELEPHONE:
LICENSING EVALUATOR NAME: Chase AthertonTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC809 (FAS) - (06/04)
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