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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300747
Report Date: 05/03/2023
Date Signed: 05/11/2023 02:59:04 PM

Document Has Been Signed on 05/11/2023 02:59 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:SHADOWRIDGE MONTESSORI SCHOOLFACILITY NUMBER:
376300747
ADMINISTRATOR:NAKHAI, SAIEDFACILITY TYPE:
850
ADDRESS:1940 SHADOWRIDGE DRTELEPHONE:
(858) 922-5128
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY: 144TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/03/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Saied NakhaiTIME COMPLETED:
02:05 PM
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On May 3, 2023 Licensing Program Analyst (LPA), Ana Noble conducted a pre-licensing inspection this date for a proposed Preschool with Toddler Option Program. The days and hours of operation will be: Monday-Friday 7:00 AM - 6:00 PM. LPA met with Saied Nakhai, Applicant who led a tour of the facility at 10:26 AM. The facility was toured inside and out, and the following was observed:

· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Filtered water in pitcher with disposable cups, supply drinking water in the indoor activity space
· Playground is enclosed by a wrought iron fencing/block walls
· Outdoor activity area is supplied with age and size appropriate equipment
· There are no accessible bodies of water present. If wading pools or similar products are used, they must be emptied immediately after use and stored in an upright position.
· An adequate amount of cushioning material rubber padding and sand is in place under play equipment
· Adequate shade is provided by canopy and pergola.
· Drinking water is provided in the outdoor play area by filter water in pitchers and disposable cups.
· Lunch will not be provided only snack - Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies
· The office area is located near the entrance next to the reception area.
· Director's office will serve as the isolation area for ill children temporarily until parents arrive
· There is a working telephone located in the facility.
· Medication will be stored in the Director's office which is inaccessible to children
· Storage area for toxins and poisons is locked, located in electrical closet in the hallway by the director's office.
· Medication administration forms were reviewed
· First Aid kit is complete with all required items.
· Facility will use electronic Sign in/Sign/ will have a hard copy as back up in case of malfunction, meets regulation requirements
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: SHADOWRIDGE MONTESSORI SCHOOL
FACILITY NUMBER: 376300747
VISIT DATE: 05/03/2023
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· Parent Board located reception area with all required forms.
· Carbon Monoxide Detector located Hallway near PANDA #1 classroom.

Measurements were taken and the following was determined:

Preschool Indoor Activity Areas-
LPA has determined that there is sufficient space to accommodate 120 Preschool Children and 25 Toddlers - Ages 18-36 (In Room Teddy Bears) For a Total 144 children.

Bathroom Fixtures
9 toilets x 15 = 135 children
15 sink x 15 = 225 children

Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 120 Preschool children in Playgrounds 1-2 and 24 Toddlers in Toddler Playground.

Limiting factor for Preschool/Toddler capacity is requested capacity. The Fire Clearance granted on 3/29/2023. Preschool capacity is limited to children 120 and Toddler Option is 24.

During the inspection, the following was reviewed with Applicant:
· Component II Orientation was completed
· The applicant was informed of their reporting requirements and provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
· The importance of checking for recalled infant (children) devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant (children) devices with the CPSC to be notified of any recalls on their purchased equipment.

· Provider Information Notice (PIN) 22-20-CCP: Resources and Requirements on Lead Testing in Child Care

· LPA reviewed 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 if the facility will provide the services.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: SHADOWRIDGE MONTESSORI SCHOOL
FACILITY NUMBER: 376300747
VISIT DATE: 05/03/2023
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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 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.

Applicant 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.

A review of staff records on 5/1/2023 indicates that the applicant and/or designated individual who is required to have caregiver background checks have received criminal record and child abuse index clearances or exemptions. The applicant can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations858@dss.ca.gov

LPA discussed the safe sleep regulations with applicant 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 applicant 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 Applicant 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.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: SHADOWRIDGE MONTESSORI SCHOOL
FACILITY NUMBER: 376300747
VISIT DATE: 05/03/2023
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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 following items need to be completed/corrected prior to a license being issued:



1. Personnel Report, LIC500
2. Job descriptions must have one for all positions (listed on LIC500), must include line of supervision. 3. Personnel Policies MUST include: Mandated Reporter Training-every 2 years and Background Clearance Information for DOJ, FBI and CACI.
4. In-Service Training Plan must include: Availability of community services and resources the missing TOPICS to be covered that are required, Housekeeping and sanitation principles, including universal health precautions, Provision of childcare and supervision, including communication. Assistance with prescribed medication that are self-administered. Recognition of early signs of illness and the need for professional assistance. Availability of community services and resources.
5. Parent Handbook MUST INCLUDE this information in handbook:
-Program Descriptions: Days and hours of operation (include holiday closures), Food service provisions (meal and snack time) if not providing lunch clearly state-NO LUNCHES WILL BE PROVIDED ONLY SNACK, Times of specific activities, Transportation arrangements – IF NO TRANSPORTATION PROVIDED STATE NO TRANSPORTATION PROVIDED, Sign in/sign out procedures-INCLUDE REGULATION REQUIREMENTS.
-Admission Policies: Criteria for determining appropriate placement (parent interviews, pre-admission appraisal, etc), Immunization requirements
-Discipline Policies: Grounds for dismissal/removal.
-Schedule of Daily Activities: Times that meals and snacks are served, Rest and Relaxation (Naptime), Times of specific activities.
6. Admission Agreement MUST include this information: Payment provisions: rate for basic services, Modification conditions (30 day notification of any rate increase), Refund policy, Termination conditions, Rights of Licensing Agency (Inspection Authority), Toddler Option statement included (written permission from the authorized representative is required).
7. List of Furniture and Play equipment: Quantity not included-How many of each items. Must be sufficient to meet the requested capacity.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: SHADOWRIDGE MONTESSORI SCHOOL
FACILITY NUMBER: 376300747
VISIT DATE: 05/03/2023
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Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 144 (120 Preschool 24 Toddler). As agreed upon by Applicant, Saied Nakhai, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied.

If all corrections are approved and facility licensed, you must have the drinking water outlets used for drinking and cooking tested for lead and post the results within 180 days of licensure. Exit interview conducted and report was reviewed with Applicant Saied Nakhai.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5