Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843324
Report Date: 06/24/2015 12:00:00 AM
Date Signed 06/24/2015 10:53:56 AM

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:AKIVA SCHOOL CDCFACILITY NUMBER:
334843324
ADMINISTRATOR:DENEBEIM, SONIAFACILITY TYPE:
850
ADDRESS:73-550 SANTA ROSA WAYTELEPHONE:
(760) 848-8250
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:25CENSUS: 0DATE:
06/24/2015
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:SONIA DENEBEIMTIME COMPLETED:
11:10 AM
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On date and time listed, Licensing Program Analyst (LPA), Dawn Parker met with the Licensee/Director and also present is the Licensee's daughter Shaina Friedman toured proposed preschool center, inside and out. The days and hours of operation will be: Monday-Friday from 7:30am - 6:00pm for ambulatory only children ages 2 years through kindergarten*. The following measurements were taken:

Indoor activity area measurements:
Classroom 1 (Main classroom): 35.1 x 17.7 = 621.27 with no encumbered space = 18 children
Classroom 2: 23 x 19.7 = 453.10 with no encumbered space = 13 children
Total indoor activity space: 1074.37 divided by 35 = 31 children

Total children toilets and sinks:
2 toilets x 15 = 30 children
2 sinks x 15 = 30 children

Outdoor activity area measurements:
Main outside activity area: 74.4 x 100+ = 7440
Patio area: 23 x 17.5 = 402.5
Total outdoor activity space: 7842.5 divided by 75 = 105+ children

Limiting factor for capacity is the fire clearance and requested capacity. Capacity is limited to 25 children.
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Dawn ParkerTELEPHONE: (951) 782-4949
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2015
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: AKIVA SCHOOL CDC
FACILITY NUMBER: 334843324
VISIT DATE: 06/24/2015
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This information will be updated at least monthly on the website and will span the preceding five-year period.

Prior to licensure the following areas/documents must be corrected/submitted:

1. Update Emergency Disaster Plan (LIC610A) to include two relocations sites which will include a statement from the site acknowledging that they will be available to this center and it must include the hours of operation for this center in the statement (statements are required if the relocation sites are businesses).
2. Obtain a Carbon Monoxide Detector and provide a copy of the receipt and a picture of the detector installed at the center.
3. Provide copies of the Pediatric CPR and First Aid cards which include the EMSA stickers.

Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 25 children ages 2 years through kindergarten. 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 may be withdrawn. An exit interview was conducted and a copy of this report was provided to the applicant on this date.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Dawn ParkerTELEPHONE: (951) 782-4949
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2015
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: AKIVA SCHOOL CDC
FACILITY NUMBER: 334843324
VISIT DATE: 06/24/2015
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The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· There is a water cooler and cups to supply drinking water in the indoor activity space
· Playground is enclosed by an appropriate fence
· Outdoor activity area is supplied with age and size appropriate equipment
· An adequate amount of cushioning material (sand) is in place under play equipment
· Adequate shade is provided
· Drinking water is provided in the outdoor play area by a water jug/pitcher and cups
· 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 off the main entrance room and will serve as the isolation area for ill children temporarily until parents arrive
· Staff bathroom will also be used as the isolation bathroom and is conveniently next to the isolation area
· Medication will NOT BE PROVIDED at this time.
    The Licensee stated that the center will not be providing incidental medical services at this time. At a time in the future when the program may wish to accept a child into care who needs this service provided, the Licensee understands that a plan of operation must be completed and submitted to licensing prior to accepting the child into care. For guidelines on how to write a plan of operation refer to the licensing website www.ccld.ca.gov in the evaluator manual and/or polices for Section 101226 Health Related Services.
· First Aid kit is complete
· Sign in/Sign out record was reviewed and meets regulation requirements
· Component II Orientation was completed during the visit
· A review of staff records on *06/24/2015* indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Dawn ParkerTELEPHONE: (951) 782-4949
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2015
LIC809 (FAS) - (06/04)
Page: 2 of 4


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: AKIVA SCHOOL CDC
FACILITY NUMBER: 334843324
VISIT DATE: 06/24/2015
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· The applicant has been informed that all employees must be associated to the facility. If the licensee fails to have proof of a fingerprint clearance or fails to associate a previously cleared individual to the facility, a civil penalty of $100.00, per day the person has been present, will be assessed. The first violation is subject to the penalty for up to five days. If there is a subsequent violation in a 12 month period, the fine will continue for up to 30 days.
· The applicant was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.
· AB 978 – Zero Tolerance Related Regulations went into effect January 18, 2011 – In accordance with California Health and Safety Code Section 1596.99(c)/1597.58(c) – it was explained that an immediate $150 Civil penalty will be assessed for each serious violation and a civil penalty of $150 per day per violation will be assessed until corrected.
· 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
- Documentation of fire & earthquake drills to be conducted every six months
- AB 2621 – Public information posted on the internet, effective January 1, 2015 – The Department shall post licensing information for Family Child Care Homes on its Internet Web site to include:
    · The Name
    · The address of each Child Care Center
    · The capacity of the license for each Child Care Center
    · The Status of the license
    · The number of citations
    · The number of site visits, including:
      · Non-complaint inspections
      · Substantiated and inconclusive complaint inspections
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Dawn ParkerTELEPHONE: (951) 782-4949
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2015
LIC809 (FAS) - (06/04)
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