364846079-7-27-2022-09-CC-SLOZ-CGPNW3-20220726104853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364846079
Report Date: 07/26/2022
Date Signed: 07/27/2022 08:20:24 AM

Document Has Been Signed on 07/27/2022 08:20 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:	FORTUNE PRESCHOOL		FACILITY NUMBER:	364846079
ADMINISTRATOR:	TENAYA WOODS		FACILITY TYPE:	850
ADDRESS:	655 W 2ND ST		TELEPHONE:	(909) 884-1410
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92410
CAPACITY: 36	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/26/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Tenaya Woods - Executive Director		TIME COMPLETED:	11:00 AM

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), Samuel Lopez, toured proposed Preschool center, inside and out. A Fire Clearance was granted on 5/26/2022. 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 54 children. Preschool Bathroom Fixtures 2 toilets x 15 = 30 children 2 sinks x 15 = 30 children A waiver has been requested for sharing restrooms with the Elementary School children Preschool Outdoor Activity Area: LPA has determined that there is sufficient space to accommodate 18 children. A waiver has been requested for the playground due to insufficient square footage Limiting factor for preschool capacity is the Fire Clearance, if waivers are approved. Preschool capacity is limited to 36 children. The following was observed: · Classrooms are adequately equipped with age and size appropriate furniture and equipment · Water fountains and personal water bottles supply drinking water in the indoor activity space

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022

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: FORTUNE PRESCHOOL	FACILITY NUMBER: 364846079
	VISIT DATE: 07/26/2022

NARRATIVE

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· 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.
· The current playground does not have structures that would require cushioning material.
· Adequate shade is provided by an EZ up and by the facility building
· Drinking water is provided in the outdoor play areas by personal water bottles that will be filled by water from the indoor water fountains
· Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies - food will be provided by an outside vendor and staff will only serve
· The office area is located near the classrooms (#3 and #4) and will serve as the isolation area for ill children temporarily until parents arrive
· Toxins are locked
· Medication will be stored in the office and will be secured in a locked cabinet
· Medication administration forms were 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 7/26/2022 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Executive Director Tenaya Woods 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.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022

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: FORTUNE PRESCHOOL	FACILITY NUMBER: 364846079
	VISIT DATE: 07/26/2022

NARRATIVE

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

LPA discussed AB 2370 and provided a copy of PIN 21-21-CCP which explains the requirement for lead testing of water. All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead. Also, for a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

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)/ (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

LPA discussed the safe sleep regulations with Executive Director Tenaya Woods and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed Executive Director Tenaya Woods 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 Executive Director Tenaya Woods 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.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022

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: FORTUNE PRESCHOOL	FACILITY NUMBER: 364846079
	VISIT DATE: 07/26/2022

NARRATIVE

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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. Waiver for restroom sharing w/Elementary School
2. Waiver for playground due to insufficient square footage
3. Pictures of additional equipment placed on the playground

Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 36. 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 Executive Director Tenaya Woods.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022

LIC809 (FAS) - (06/04)

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