Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818811
Report Date: 06/14/2017
Date Signed: 06/14/2017 03:11:03 PM

COMPREHENSIVE INSPECTION
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:CALVARY CHAPEL ACADEMY PRESCHOOLFACILITY NUMBER:
334818811
ADMINISTRATOR:ANGIE KUBELFACILITY TYPE:
850
ADDRESS:26121 HEMET STREETTELEPHONE:
(951) 927-6117
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:54CENSUS: 18DATE:
06/14/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Assitant Director, Michelle CortesTIME COMPLETED:
03:15 PM
NARRATIVE
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(2) A random annual visit is being conducted as part of a compliance review. Licensing Program Analyst (LPA), Sharleen Robinson met with Assistant Director Michelle Cortes. LPA toured the center, inside and out. The following was observed:

· A review of the staff records and a review of a sampling of children's records were conducted as part of this evaluation. (See LIC811 confidential names list)
· The facility 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 (only if changes have been made)
5. LIC 308 Designation of Administrative Responsibility (only if changes have
been made)
· 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
- Menu
· There were 18 children in care. The facility is operating within the terms of the license, ratios were met during this visit and appropriate supervision was provided.

· Classrooms are equipped with age appropriate furniture and equipment in good condition, classrooms appear to be are clean and free of hazards, and all floors appeared to be clean and safe.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 7


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: CALVARY CHAPEL ACADEMY PRESCHOOL
FACILITY NUMBER: 334818811
VISIT DATE: 06/14/2017
NARRATIVE
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·No weapons stored at the facility, per the Assistant Director.

· There are no accessible bodies of water present. The facility Assistant Director was advised all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.

· Medications are stored in the office area in a locked cabinet; hazards are stored where inaccessible to children which include: disinfectants, cleaning solutions and other items that are dangerous to children, poisons and toxins are locked.

· Bathrooms were observed to be safe, sanitary and in operating condition

· Playgrounds are enclosed by appropriate fences and free of hazards, outdoor activity areas are supplied with age and size appropriate equipment in good condition.

· 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 shall have tight-fitting covers that are kept on, and in good repair.

· Uncontaminated drinking water is readily available both indoors and out and is provided by operational water fountains and water pitchers.

· The areas around and under high climbing equipment and similar equipment is cushioned with material that absorbs a fall.

· Sign in/Sign out record was reviewed and meets regulation requirement

· A Staff member is present with current Pediatric CPR/First Aid which expires on 1/28/18

· Opening and closing staff member’s CPR/First Aid expires on 10/31/18. The Director had Health and Safety training certificate on file.

· Records were reviewed ensuring the children’s files contain the names and contact information of authorized representatives and others who can assume responsibility for the child when necessary
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2017
LIC809 (FAS) - (06/04)
Page: 3 of 7


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: CALVARY CHAPEL ACADEMY PRESCHOOL
FACILITY NUMBER: 334818811
VISIT DATE: 06/14/2017
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·Records were reviewed ensuring that the staff files contain documentation of the educational background, training and/or experience required.

· Documentation of fire & earthquake drills to be conducted every six months last drills conducted 5/4/17

· A review of staff records on June 12, 2017 indicates that facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

· ·The facility is not currently providing IMS Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

· ·The Assistant Director advised, for more information on SIDS and Safe Sleep Environments, please visit: California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Rick-of-SIDS-in-Early-Education-and-Child-Care And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

The following was also reviewed and discussed:

v AB 2084 - Nutritious Beverages in Child Care Facilities effective January 1, 2012 - was explained that only low-fat or non-fat milk is to be served to children 2 years of age or older; and limit juice to one serving of 100% juice per day; serve no beverages with added sweeteners; and water must be available and accessible to children throughout the day
v AB 2621 – Public Information effective January 1, 2015 – The Department shall post licensing information for Child Care Facilities on it’s internet Web site to include:
· The name
· The address for each Child Care Center only
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2017
LIC809 (FAS) - (06/04)
Page: 4 of 7


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: CALVARY CHAPEL ACADEMY PRESCHOOL
FACILITY NUMBER: 334818811
VISIT DATE: 06/14/2017
NARRATIVE
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v Access to forms & Regulations for Child Care online at www.ccld.ca.gov. Please subscribe to My CCL at http://www.myccl.ca.gov/idms.asp. Department updates will be sent directly to your e-mail account once you have set up an account.
v The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

An exit interview was conducted and during the interview, the Director Michelle Cortes Confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address

An exit interview was conducted, appeal rights discussed, Notice of Site Visit was posted and must stay posted for 30 days. A copy of this report was provided to Assistant Director on this date. Upon receipt of this report, licensee or designated facility representative is required to provide copy of the LIC809D documenting Type A deficiency to children's parents and obtain signatures from the parents on Form LIC9224. For the next 12 months, licensee or facility representative is required to provide copy of the LIC809D to all newly enrolled families. Form LIC9224 was provided to the licensee at time of visit.


A NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2017
LIC809 (FAS) - (06/04)
Page: 6 of 7


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: CALVARY CHAPEL ACADEMY PRESCHOOL
FACILITY NUMBER: 334818811
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2017
Section Cited
1596.954
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Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12.
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The Assistant Director Agrees to purchase and install a carbon monoxide detector by 6/15/17. The Assistant Director agrees to send LPA a picture BY 6/15/17.
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The department shall account for the presence of these detectors during inspections. During the tour of the facility, LPA Robinson did not observe a Carbon Monoxide detector present. The Assistant Director could not locate one.
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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: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2017
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: CALVARY CHAPEL ACADEMY PRESCHOOL
FACILITY NUMBER: 334818811
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2017
Section Cited
H&S 1596.799
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SB 792 – Effective September 1, 2016, a person may not be employed or volunteer at a child care center or a family child care home unless he or
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The Assistant Director agrees to submit proof of her immunizations against pertussis by July 14, 2017.
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she has been immunized against influenza, pertussis, and measles or qualifies for an exemption (Health and Safety Code sections 1596.7995(a)>>>>>>
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(1) and 1597.622(a)(1). The Assistant Director did not have immunizations against pertussis on file. This poses a potential risk to the Health and Safety of children in care due to staff not being immunized against influenza, pertussis, measles and/or by not having a medical exemption.
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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: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2017
LIC809 (FAS) - (06/04)
Page: 7 of 7


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: CALVARY CHAPEL ACADEMY PRESCHOOL
FACILITY NUMBER: 334818811
VISIT DATE: 06/14/2017
NARRATIVE
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·The status of the license
· The capacity of the license for each Child Care Center only
· The number of site visits, including:
o Non-complaint inspections
o Substantiated and inconclusive complaint inspections
· The number of citations
This information is to be updated at least monthly on the website and will span the preceding five-
year period.
v AB 2236 – Civil Penalties, effective July 1, 2015 – Enacts new civil penalties in cases where the Department determines that a violation of licensing standards resulted in the death or serious injury, or constitutes physical abuse of a child in care. The bill establishes an appeal procedure specific to these civil penalties. The bill also expands the scope of the Child Health and Safety Fund in order to assist parents in securing alternative child care when a Child Care Center license has been suspended or revoked. These civil penalty amounts are scaled in relation to the total capacity of all of the licensee’s facilities and not just the specific facility cited or limited to that facility type.
v AB 2386 – Carbon Monoxide Detector Regulations, effective January 1, 2015 – In accordance with California Health and Safety Code Section 1975.543 - Every child care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspection. The facility did not have a carbon monoxide detector, see LIC809D for citation.
v - SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 - it eliminates the exemption from existing specified immunization requirements based upon personal beliefs, and only allows an exemption from future immunization requirements deemed appropriate by the State Department of Public Health or a medical professional for medical reasons.
v - AB290 – Child Nutrition, effective January 1, 2016 - In accordance with California Health and Safety Code Section 1596.866 - each child care center shall have at least one person employed who was completed one hour of childhood nutrition training as part of the preventive health practices course or courses.
v - SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 1597.622 - a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination or they may provide a statement declining the vaccination. If employees/volunteers are receiving the influenza vaccination they must do so between August 1 and December 1 of each year. Staff #2 did not have proof that they are immunized against pertussis on file, see LIC809D for citation.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2017
LIC809 (FAS) - (06/04)
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