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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300358
Report Date: 09/19/2023
Date Signed: 09/19/2023 02:47:42 PM

Document Has Been Signed on 09/19/2023 02:47 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:COLES COTTAGE ACADEMYFACILITY NUMBER:
376300358
ADMINISTRATOR:COSTA,WEERATUNGAFACILITY TYPE:
850
ADDRESS:505 CIVIC CENTER DRTELEPHONE:
(949) 836-4465
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 29DATE:
09/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Brenda MesaTIME COMPLETED:
03:00 PM
NARRATIVE
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On September 19, 2023 at 12:00 pm, Licensing Program Analyst (LPA), Jessica Rubio conducted an annual inspection as part of a compliance review. This is a combination childcare center, and the other licensed program is Infant, which was also inspected on this date. A tour of the inside and outside of the facility was granted and the following was observed and/or noted:

· The following items were posted and 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
- Menu
· The facility is operating within the limits as stated on the license. LPA observed 29 children in care.
· Ratios are being met during this inspection. LPA observed 8 children in one class with one teacher providing care, 11 children in another class with one teacher providing care and 10 children in another class with one teacher providing care.
· Classrooms are adequately equipped with age and size appropriate furniture and equipment and free of hazards
· There are no weapons present at the facility as stated by Facility Representative Brenda Mesa.
· 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.
· Drinking water is provided in the indoor and in the outdoor activity space by public filtered water supply.
· Medications are stored where inaccessible to children in the main office.
· Hazardous items are stored where inaccessible to children which include disinfectants, cleaning solutions and other items that are dangerous.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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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Document Has Been Signed on 09/19/2023 02:47 PM - It Cannot Be Edited


Created By: Jessica M Rubio On 09/19/2023 at 01:03 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: COLES COTTAGE ACADEMY
FACILITY NUMBER: 376300358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 licensee did not comply with the section cited above as one staff was missing immunization recods, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/19/2023
Plan of Correction
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Facility Representative Brenda Mesa, stated that documentation would be obtained and provided to LPA by plan of correction due date.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as one staff was missing a health screening and tuberculosis test which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/19/2023
Plan of Correction
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Facility Representative Brenda Mesa, stated that documentation would be obtained and provided to LPA by plan of correction 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:Pauline Beschorner
LICENSING EVALUATOR NAME:Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023


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Document Has Been Signed on 09/19/2023 02:47 PM - It Cannot Be Edited


Created By: Jessica M Rubio On 09/19/2023 at 01:31 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: COLES COTTAGE ACADEMY
FACILITY NUMBER: 376300358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(o)(1)
(o) Playground equipment shall be securely anchored to the ground unless it is portable by design.
(1) Equipment shall be maintained in a safe condition, free of sharp, loose or pointed parts.

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 as there were several broken tricycles and a ripped teeter totter seat, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2023
Plan of Correction
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Facility Representative Brenda Mesa stated the items would be removed and/or replaced or repaired and proof would be sent to LPA.
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:Pauline Beschorner
LICENSING EVALUATOR NAME:Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023


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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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: COLES COTTAGE ACADEMY
FACILITY NUMBER: 376300358
VISIT DATE: 09/19/2023
NARRATIVE
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·All floors were observed to be safe and clean.
· Bathrooms were observed to be safe, sanitary and in operating condition
· Playgrounds are enclosed by appropriate fences.
· Outdoor activity areas are supplied with age and size appropriate equipment. LPA observed several tricycles that were missing seats and three that had broken seat backs as well as the seat on the teeter totter was ripped. A citation will be issued.
· Food preparation area is clean, free of litter and rubbish and free of rodents and other vermin
· Food is stored appropriately and protected from contamination
· All storage containers for solid waste were observed to have tight-fitting covers that are kept on, and in good repair
· Sign in/Sign out records were reviewed and meet regulation requirements
· Disaster drills are conducted at least every six months, however drills are not being documented. A technical violation will be issued.

A review of three staff and five children's records were conducted as part of this evaluation.

· One child (Ref#1) did not have a tuberculosis risk assessment documented on the physician’s report. A technical violation will be issued.


· One staff (Ref#3) did not have documentation of measles and pertussis immunizations and did not have documentation of a health screening or tuberculosis test on file. Citations will be issued.
· Staff record review indicates that all staff present meet minimum qualifications for the position for which they were hired.
· A staff member is present with current Pediatric CPR/First Aid which expires on 9/2024.
· Opening and closing staff member’s CPR/First Aid expires on 9/2024
· Director completed Health and Safety Training 12/2007 and 1/2008
· A review of staff records 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send them email inquiries 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.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: COLES COTTAGE ACADEMY
FACILITY NUMBER: 376300358
VISIT DATE: 09/19/2023
NARRATIVE
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP)

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

For IMS information see PIN 22-02-CCP.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, are available at: https://www.ada.gov/resources/child-care-centers/

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The Licensee was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: COLES COTTAGE ACADEMY
FACILITY NUMBER: 376300358
VISIT DATE: 09/19/2023
NARRATIVE
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The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov

On-line Licensing forms & regulations for a Child Care Center can be obtained on the Department’s website: www.ccld.ca.gov. Additionally, there is a link to “Receive Important Updates” located on the right side of the page, immediately above Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200

The Facility Representative was 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 or file copy is more than 2 years old)
4. LIC 309 Administrative Organization (only if changes have been made or file copy is more than 2 years old)
5. LIC 308 Designation of Administrative Responsibility (only if changes have been made& current designation is on file)

The facility is being cited for Health & Safety Code and Title 22 Regulations. See LIC809-D for cited deficiencies.

During the exit interview, the Facility Representative Brenda Mesa, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Exit interview was conducted, and this report was reviewed with the Office Manager Brenda Mesa. Appeal rights were discussed and provided during the exit interview. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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