<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371555
Report Date: 06/07/2022
Date Signed: 06/20/2022 01:09:26 PM

Document Has Been Signed on 06/20/2022 01:09 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SHINE PRESCHOOL CENTERFACILITY NUMBER:
304371555
ADMINISTRATOR:TOFOYA, RAYLEENFACILITY TYPE:
850
ADDRESS:12832 KNOTT STREETTELEPHONE:
(714) 443-1284
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 0DATE:
06/07/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Ms.Tofoya,Rayleen TIME COMPLETED:
01:15 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
Licensing Program Analyst (LPA) Ms. Ketki Desai conducted an announced on site pre-licensing inspection at the childcare center. It is a New center. LPA met with the Administrator/ Applicant Ms. Tofoya, Rayleen who gave a tour of the Child Care Center on the premises of The Cavalry Chapel West Grove Church. Three rooms and outdoor play yard is designated to the Child Care Center.

The applicant has requested to provide care and supervision for 48 Pre-school age children 2 to 6 years of age, Monday through Friday 7:00 AM. to 6.00 PM. in the assigned three classrooms. (Room # 2 a/b, 4 and 6)

LPA observed staff following CDC and Dept of Public Health Guidelines. Due to COVID Pandemic parents shall be encouraged to follow the CDC and COVID requirements, children shall be received at the entrance glass door in front of the left hand side parking lot. The glass door remains locked, parents shall use an access code to gain entrance into the facility, a Preschool staff member shall be in the lobby to receive the child. The classrooms are in front of the lobby area. Upon arrival each child has an health evaluation along with hand washing before they participate in the classroom activities. Parents sign them electronically using an application called Bright-Wheel

A review of the Facility Personnel Report Summary on this date 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 facility is on the premises of Cavalry Chapel West grove Church, the additional classrooms are assigned to the Church school from Kindergarten to 6th grade.

Isolation area: The church has a designated room # 1, across the lobby to be used for the sick child to be isolated. This room is not approved for Child care services.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHINE PRESCHOOL CENTER
FACILITY NUMBER: 304371555
VISIT DATE: 06/07/2022
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
26
27
28
29
30
31
32
LPA discussed the posting requirements including, but limited to, the following: ( Posters are posted in each classrooms and at the entrance of the facility)

· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610)
· Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393)
· Personal Rights (LIC 613A)
· Menus / Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies / Plan of Corrections of Type A deficiencies
· Granted Waivers (available for review)
· Child Car Seat Law (PUB 269) & · COVID Posters.

The following were inspected in the indoor activity space:
· Classroom are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside through personalized water bottles and water pitchers in each preschool rooms.
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Electronic sign in and out)
· Facility has built in smoke detector, carbon monoxide detector, along with Sprinkler system and fire extinguishers in the lobby area that meet statutory requirements.
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· Napping equipment: Cots are used and are stored in the corner of the classroom, napping linens and blankets are provided by the parents, facility also has additional linens if needed.
· Facility provides AM/PM snacks, lunch is brought from home. This containers are labelled and stored in the individual cubbies.
Rooms are well lighted with proper ventilation
Each room has age appropriate activity items and space to move around.
Room # 6 has a changing table along with small baby toilet and is designated for younger Preschool age children between 2-3 only. (2)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHINE PRESCHOOL CENTER
FACILITY NUMBER: 304371555
VISIT DATE: 06/07/2022
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
26
27
28
29
30
31
32
LPA measured the four assigned Preschool rooms . Room # 2a & 2b is a big classroom, it has a divided in-between but applicant plans to use as one classroom.

Indoor activity space : 2464'85 divided by 35 = 70 children
Facility has sufficient indoor activity space to accommodate the requested capacity of 48 children.

Total sinks : 9 X 15= 135 children / Total Toilets: 7 X 15= 105 children ( There are additional toilets and sinks on the premises) But the above,sinks and toilets are designated for Preschool use only. Room # 2 a&b has one toilet and 2 sinks inside the classroom, while there is one baby toilet and 3 sinks in between room # 4&6, including addition toilets and sinks in front of Room # 2 a&b, which are designated to Preschool children.

Facility has age appropriate sinks and toilets in the classrooms and adjoining the outdoor play area.

Preschool outdoor play yard:



Facility has designated Preschool yards and following was observed:
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by water fountains and personal water bottles
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures and outdoor activity toys,
· An adequate amount of soft cushioning is in place under the play structure to absorb the falls
· Adequate shade is provided by shaded structure (Sail & trees )and roof line shade.
· There is also a bike trail area and a cemented open area for children to play. Older preschool children shall walk through the lobby area to access the play yard. While younger preschool children have direct access from the classroom to the play yard.
The play structure is appropriate for ages of the preschool to be served. There is an exit door at the end of the play yard with a lock on the latch and the keys is with the Church authorities.

Play yard also has sufficient shade and activities for children. (3)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHINE PRESCHOOL CENTER
FACILITY NUMBER: 304371555
VISIT DATE: 06/07/2022
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
26
27
28
29
30
31
32
Total outdoor activity space: 3297'45= 43

Based on the indoor measurements, sink and toilet availability, facility has sufficient space to accommodate the requested capacity of 48 Preschool age children (2-6 years old) in the assigned three classrooms. Facility does not have sufficient outdoor space to accommodate the requested capacity. A waiver for staggered schedule shall be submitted.
Facility shall also submit an additional waiver for sharing the play yard with the Church school on premises.

Fire clearance received from Orange county Fire Authority approving the requested capacity of 48 children
in the three rooms.

Applicant Ms. Tofoya, Rayleen is current on the required Immunization/ Pediatric CPR/ First training valid through July 27th 2022 and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component and Mandated Child abuse reporting training.

Following items were discussed at the time of Exit interview.
Criminal Record Statement : Applicant, Tofoya,Rayleen 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.

Safe Sleep : LPA discussed the safe sleep regulations with applicant Ms. Tofoya,Rayleen discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] 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. (4)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHINE PRESCHOOL CENTER
FACILITY NUMBER: 304371555
VISIT DATE: 06/07/2022
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
26
27
28
29
30
31
32
Incidental Medical Services (IMS) 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

Review of records to be maintained : LPA reviewed with applicant, the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Subscribe to CCLD important information

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 license-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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

A license for 48 Preschool age children (2-6 years) in three assigned Rooms : 2 a / b, 4 and 6 .


Monday to Friday 7.00 am to 6.00 PM, shall be issued upon management approval.

Report read and appeal rights presented to the applicant.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5