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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846074
Report Date: 05/05/2022
Date Signed: 05/05/2022 03:08:01 PM

Document Has Been Signed on 05/05/2022 03:08 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:SHINE PRESCHOOL CENTERFACILITY NUMBER:
364846074
ADMINISTRATOR:ALICIA BUEZISFACILITY TYPE:
850
ADDRESS:5559 PARK PLACETELEPHONE:
(714) 443-1284
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/05/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Applicant Rayleen TafoyaTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA), Samuel Lopez, toured proposed Preschool center, inside and out. A Fire Clearance was granted on 8/11/2021. The days and hours of operation will be: Monday through Friday, 7:00am to 6:00pm. Measurements were taken and the following was determined:

Preschool Indoor Activity Areas
LPA has determined that there is sufficient space to accommodate 69 children.

Preschool Bathroom Fixtures
8 toilets and 2 urinals x 15 = 150 children
11 sinks x 15 = 165 children

Preschool Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 98 children.

Limiting factor for preschool capacity is the Fire Clearance. Preschool capacity is limited to 30 children.

The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Jugs filled with filtered water will supply drinking water in the indoor activity space
· Playgrounds are 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 mulch) is in place under play equipment
· Adequate shade is provided by a canopy, trees in the picnic area, and the buildings also provide shade
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2022
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: SHINE PRESCHOOL CENTER
FACILITY NUMBER: 364846074
VISIT DATE: 05/05/2022
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LPA also informed Applicant, Rayleen Tafoya of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA reviewed with Applicant, Rayleen Tafoya the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

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.

The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:


1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200

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

1. IMS Plan
2. Knob cover/lock on the door that leads to the nursery in room 1

Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 30. 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.

Exit interview conducted and report was reviewed with the Applicant, Rayleen Tafoya.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
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: SHINE PRESCHOOL CENTER
FACILITY NUMBER: 364846074
VISIT DATE: 05/05/2022
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· Drinking water is provided in the outdoor play areas by jugs filled with filtered water
· Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, but not adequate amount of food supplies since the plan is not to open in summer
· The office area will serve as the isolation area for ill children temporarily until parents arrive
· Toxins are locked
· Medication will be stored in the front office and will be secured in a locked cabinet
· Medication administration forms were NOT reviewed
· First Aid kit is complete
· Sign in/Sign out record was reviewed and meets regulation requirements
· Component II Orientation was completed during this inspection
· 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
· A review of staff records on 5/5/2022 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Applicant, Rayleen Tafoya was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The applicant can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

This facility plans to provide Incidental Medical Services (IMS). For IMS information, see PIN 22-02-CCP. A 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
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
LIC809 (FAS) - (06/04)
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