364846434-8-29-2023-09-CC-SLOZ-CV6MTH-20230829095334

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364846434
Report Date: 08/29/2023
Date Signed: 08/29/2023 09:53:43 AM

Document Has Been Signed on 08/29/2023 09:53 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:	CJUSD/SYCAMORE HILLS		FACILITY NUMBER:	364846434
ADMINISTRATOR:	WILLIAMSON,MELISSA		FACILITY TYPE:	850
ADDRESS:	11036 MAHOGANY DR.		TELEPHONE:	(909) 580-5031
CITY:	FONTANA	STATE: CA	ZIP CODE:	92337
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/29/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	07:52 AM
MET WITH:	Director Melissa Williamson		TIME COMPLETED:	10:10 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 7/26/2023. The days and hours of operation will be: Monday through Friday, 8:00am to 3:00pm. Measurements were taken and the following was determined: Preschool Indoor Activity Areas LPA has determined that there is sufficient space to accommodate the requested capacity of 24 children. Preschool Bathroom Fixtures 2 toilets x 15 = 30 children 2 sinks x 15 = 30 children (waiver was requested to share restrooms with adjacent classroom N2) Preschool Outdoor Activity Area:* LPA has determined that there is sufficient space to accommodate more than the requested capacity of 24 children. (waiver was requested to share playground with TK and Kindergarten Programs) Limiting factor for preschool* capacity is the Fire Clearance granted and the approval of the restroom waiver. Preschool capacity is limited to 24 children. The following was observed: · Classrooms are adequately equipped with age and size appropriate furniture and equipment · Drinking fountain will supply drinking water in the indoor activity space · Playgrounds are enclosed by appropriate fences

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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/SYCAMORE HILLS	FACILITY NUMBER: 364846434
	VISIT DATE: 08/29/2023

NARRATIVE

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· 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 (wood chips) is in place under play equipment
· Adequate shade is provided by trees
· Drinking water is provided in the outdoor play areas by drinking fountain located on the playground
· Food is prepared at the Elementary School cafeteria and delivered to the classroom. Staff will serve food only.
· The nurses office is located at the entrance and will serve as the isolation area for ill children temporarily until parents arrive
· Toxins are locked
· Medication will be stored in a locked box and will be secured in a locked cabinet in the classroom
· Medication administration forms were previously 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 8/29/2023 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Director Melissa Williamson 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.

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

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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/SYCAMORE HILLS	FACILITY NUMBER: 364846434
	VISIT DATE: 08/29/2023

NARRATIVE

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LPA discussed AB 2370 and provided a copy of PIN 21-21.1-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.
For more information visit:
https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

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

LPA also informed Director Melissa Williamson 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 Director Melissa Williamson 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

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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/SYCAMORE HILLS	FACILITY NUMBER: 364846434
	VISIT DATE: 08/29/2023

NARRATIVE

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

1. Waivers submitted and approved (Playground and restrooms)

Once all corrections have been made, with proof sent to licensing, and final review from management, the application will be submitted for approval with a maximum capacity of 24. 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 Director Melissa Williamson.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC809 (FAS) - (06/04)

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