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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364805267
Report Date: 05/22/2023
Date Signed: 05/22/2023 02:52:47 PM

Document Has Been Signed on 05/22/2023 02:52 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:CJUSD/GRANTFACILITY NUMBER:
364805267
ADMINISTRATOR:MELISSA MACKFACILITY TYPE:
850
ADDRESS:550 W. OLIVE STREETTELEPHONE:
(909) 876-4126
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY: 24TOTAL ENROLLED CHILDREN: 21CENSUS: 18DATE:
05/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Liza (Elizabeth) Gurrola, instructional aid/lead teacherTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Aman Sharma conducted a required/annual inspection. LPA was met with instructional aid/lead teacher, Liza (Elizabeth) Gurrola. An inside out tour of the facility was given and the following was observed and/or noted:
A review of staff and children's records were reviewed as part of this inspection.
· The licensee/director 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
5. LIC 308 Designation of Administrative Responsibility
6. A complete directors packet for the person(s) that will be available on-site during daycare hours.
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
-See something, say something poster
- Food menu.
· The facility is operating with the limits as stated on the license.
· Ratios were met during this inspection
· Classrooms are adequately equipped with age and size appropriate furniture and equipment and are free of hazards.
· There are no weapons present at the facility
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2023
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: CJUSD/GRANT
FACILITY NUMBER: 364805267
VISIT DATE: 05/22/2023
NARRATIVE
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·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.
·There was no proof of water lead testing posted. No one in the school was able to find out if it was ever tested-SEE LIC809D.
· Medications are stored where they are inaccessible to children,
· Hazards were observed to be accessible to daycare children. These include: Disinfectants, cleaning solutions and other items that are dangerous to the health and safety of children in care-SEE LIC809D
· Poisons and toxins were not observed in the classroom.
· All floors were observed clean and safe and shall remain so at all times
· 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 in good condition and supplied with age/size appropriate equipment.
· 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 tight-fitting covers that were observed to be on and in good repair.
· The areas around or under high climbing equipment, swings, slides, and similar equipment were cushioned with material that absorbs a fall- SEE advisory notes
· Sign in/Sign out record was reviewed and meets regulation requirements.
· One staff member was present with current Pediatric CPR/First Aid on file.
· Director completed Health and Safety Training, which is on file.
· A review of both, staff and children’s records was conducted, and records were found to be incomplete during this inspection- SEE LIC809D
· Disaster drills are to be conducted every six months, but the school conducts drills each month – last drill was conducted on 05/05/23
· The instructional aide/lead teacher was informed of reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· A review of staff records 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 can submit transfer forms to associate or disassociate someone from their facility at: Associations_Disassociations862@dss.ca.gov
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
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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: CJUSD/GRANT
FACILITY NUMBER: 364805267
VISIT DATE: 05/22/2023
NARRATIVE
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·A review of staff records indicates that all staff that were present meet minimum qualifications for the position for which they were hired.

- This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records to be complete. 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

- The facility is reminded that all adults 18 and over, 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.

- Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

- To access on-line Licensing forms & Regulations for a Child Care Center please visit: www.ccld.ca.gov.

- 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

Exit interview conducted and report was reviewed with the instructional aide/lead teacher, Liza (Elizabeth) Gurrola.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/22/2023 02:52 PM - It Cannot Be Edited


Created By: Aman Sharma On 05/22/2023 at 01:53 PM
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: CJUSD/GRANT
FACILITY NUMBER: 364805267

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238(g)
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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the facility did not comply with the section cited above. LPA observed chemicals in the classroom which were accessible to the children in care. These included: "bactive" sanitizing wipes, clorox wipes, alcohol pads, emergency disaster kits, which were store in two buckets full of all items in plastic bags, needed during an emergency disaster. All items had "KEEP OUT OF REACH OF CHILDREN" on the outside packaging. These items were stored in two tall storage cabinets and cabinet underneath the sink. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2023
Plan of Correction
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The lead teacher was able to get evertyhing put away and locked in the tall storage cabinets. The custodian was able to remove the buckets right away and later brough them back to store underneath the kitchen sink. The custodian also put a key lock on the doors, making all items inaccessible to daycare children.
Type A
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. The cabinet under the sink had chemicals stored underneath which were hazardous to children in care. No lock was placed on the door, instead, it was blocked off with a step-stool, making it accessible to children in care. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2023
Plan of Correction
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The custodian was able to remove the hazardous itmes and later brough them back to store underneath the kitchen sink. The custodian was able to put a key lock on the doors, making all items inaccessible to daycare children.
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:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023


LIC809 (FAS) - (06/04)
Page: 4 of 11
Document Has Been Signed on 05/22/2023 02:52 PM - It Cannot Be Edited


Created By: Aman Sharma On 05/22/2023 at 01:53 PM
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: CJUSD/GRANT
FACILITY NUMBER: 364805267

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and lack of record review, the facility did not comply with the section cited above. Upon asking the school if there was lead testing done, no one was able to confirm nor deny that the testing was ever conducted. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2023
Plan of Correction
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The facility agrees to submit proof of a scheduled testing for the school, no later than POC due date. Once testing is conducted, all forms required for lead testing must be submitted to licensing asap.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above in 4 out of 4 persons. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2023
Plan of Correction
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The director agrees to submit proof of missing immunizations for each staff to licensing, no later than 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.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023


LIC809 (FAS) - (06/04)
Page: 5 of 11
Document Has Been Signed on 05/22/2023 02:52 PM - It Cannot Be Edited


Created By: Aman Sharma On 05/22/2023 at 01:53 PM
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: CJUSD/GRANT
FACILITY NUMBER: 364805267

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) 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 is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above in 6 out of 6 childrens records. None of the children had an LIC627 Consent for Emergency medical treatment on file. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/26/2023
Plan of Correction
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The facility agrees to obtain LIC627 for each child enrolled in the program. Once the form is recieved, it should be placed in each child's respective file. The facility agrees to implement this form in their checklist for forms required in each child's file. Proof of LIC627 for each child listed on the LIC857 must be submitted to licensning, no later than 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.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023


LIC809 (FAS) - (06/04)
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