364846073-9-30-2021-09-CC-KLEG-C7CPPA-20210930112912

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364846073
Report Date: 09/24/2021
Date Signed: 09/30/2021 11:29:22 AM

Document Has Been Signed on 09/30/2021 11:29 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	EVERBROOK ACADEMY, LLC DBA PRESTIGE PRESCH ACAD		FACILITY NUMBER:	364846073
ADMINISTRATOR:	VAN DUZER, MARGARET GALE		FACILITY TYPE:	830
ADDRESS:	3040 CHINO AVE		TELEPHONE:	(909) 591-7574
CITY:	CHINO HILLS	STATE: CA	ZIP CODE:	91709
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 0	CENSUS: 12	DATE:	09/24/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:36 AM
MET WITH:	Renu Van Battum, Gale Van Duzer		TIME COMPLETED:	12:20 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	This is a change of ownership application. Facility is currently operating. Licensing Program Analyst (LPA) Kim Leung conducted a prelicensing inspection at the facility this date on 9/24/2021. Upon arrival, LPA met with applicant representative Renu Van Battum and facility director Gale Van Duzer. LPA toured proposed Preschool center, inside and out. The days and hours of operation will be: Monday through Friday from 6:30am to 6:30pm. Measurements of the indoor and outdoor activity space are on file. Infant Indoor Activity Areas LPA has determined that there is sufficient indoor activity space to accommodate 28 children. Infant Bathroom Fixtures There are 2 sinks and one toilet in the Toddler Room and 2 sinks in the Infant Room. Infant Outdoor Activity Area: LPA has determined that there is sufficient outdoor activity space to accommodate 28 children. Limiting factor for infant capacity is indoor and outdoor activity space. Infant capacity is limited to 28 children. The following was observed: · Classrooms are adequately equipped with age and size appropriate furniture and equipment · There are changing tables within arm’s reach of sinks in each of the activity rooms · Drinking water is provided by use of igloos of water, disposable cups, sippy cups and infant bottles

Aaron Ross
Kim Leung
	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

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: EVERBROOK ACADEMY, LLC DBA PRESTIGE PRESCH ACAD	FACILITY NUMBER: 364846073
	VISIT DATE: 09/24/2021

NARRATIVE

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· Playground is enclosed by appropriate fences
· Outdoor activity areas are supplied with age and size appropriate equipment
· 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.
· An adequate amount of cushioning material (rubber filler) is in place under play equipment
· Adequate shade is provided by the shade structure
· Kitchen is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies. Each activity room has a refrigerator for storage of infant formula, and food
· The office area is located at the front and will serve as the isolation area for ill children temporarily until parents arrive
· Staff/adults' bathroom will also be used as the isolation bathroom and is conveniently located to the isolation area
· Medications are stored in the kitchen and will be secured in a locked box. Diaper creme is stored in activity rooms where inaccessible to children.
· The applicant states that they plan to provide Incidental Medical Services (IMS) at this time. A written plan including IMS is on file.
· First Aid kit is complete
· Electronic sign in/out that each of the authorized representatives is assigned a unique PIN for checking in and out children. Facility will use paper sign in/out in case of power outage or system malfunctions.
· The applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· Needs and Services plans were reviewed and discussed and must be updated at least quarterly or whenever needed.
· There are sufficient cribs and/or mats for each child. Director agrees to conduct regular inspection of the crib mattresses to ensure the mattresses are in safe condition and without any exposed foam.
· There is a separate napping area

SUPERVISOR'S NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

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: EVERBROOK ACADEMY, LLC DBA PRESTIGE PRESCH ACAD	FACILITY NUMBER: 364846073
	VISIT DATE: 09/24/2021

NARRATIVE

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· A review of staff records on 9/24/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
· The applicant has been informed that all employees must be associated to the facility. If the licensee fails to have proof of a fingerprint clearance or fails to associate a previously cleared individual to the facility, a civil penalty of $100.00, per day the person has been present, will be assessed. The first violation is subject to the penalty for up to five days. If there is a subsequent violation in a 12-month period, the fine will continue for up to 30 days.
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
· The applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must be posted for 30 days.
The following was also reviewed and discussed:
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 Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
· 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-Risk-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

SUPERVISOR'S NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

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: EVERBROOK ACADEMY, LLC DBA PRESTIGE PRESCH ACAD	FACILITY NUMBER: 364846073
	VISIT DATE: 09/24/2021

NARRATIVE

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Updated information was provided to the applicant on LIC809 Facility Evaluation Report dated 9/25/2021 for the preschool program, facility #364846072.

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

The following items need to be completed/corrected prior to a license being issued:

1. Provide sufficient crib mattresses that are in safe condition without exposed foam.

A fire clearance is on file. Once the correction has been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 28 infants, ages 6 weeks to 24 months. As agreed upon by the applicant, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied. An exit interview was conducted and a copy of this report was provided to the applicant on this date.

COVID-19 RAST (Rapid Assistance Support Team) inspection was conducted this date during the same visit. Self-Assessment on file.

A copy of this report must be made available to the public for 3 years.

SUPERVISOR'S NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

LIC809 (FAS) - (06/04)

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