Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843516
Report Date: 08/14/2015 12:00:00 AM
Date Signed 08/14/2015 01:58:03 PM

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:RUSD/HARRISON ELEMENTARY SCHOOL-ROOM 3FACILITY NUMBER:
334843516
ADMINISTRATOR:JAMELIA OLIVERFACILITY TYPE:
850
ADDRESS:2901 HARRISON STREETTELEPHONE:
(951) 352-8290
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:24CENSUS: 0DATE:
08/14/2015
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Joseph NietoTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA), Samuel Lopez toured proposed Preschool Center inside and out, which is located on the grounds of Harrison Elementary School. The days and hours of operation will be: Monday through Friday, 8:00am to 11:00am. The following measurements were taken:

Indoor activity area measurements:
Classroom 3: 29' 9" sq. ft. x 29' 3" sq. ft. = 870.19 sq. ft.

Total indoor activity space: 870.19 sq. ft. divided by 35 = 24 children

Total children toilets and sinks:
6 Toilets x 15 = 90 children
3 Urinals x 15 = 45 children
6 sinks x 15 = 90 children
Toilets and sinks at Harrison Elementary will be used/shared with the Preschool
Waiver to use/share the toilets and sinks was submitted and granted.

Outdoor activity area measurements:
LPA Lopez observed sufficient amount of outdoor activity space/playground for the capacity requested. The Preschool will be sharing a outdoor activity space/playground that is also used by the children of Harrison Elementary.
Waiver to share the outdoor activity space/playground was submitted and granted.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 782-4951
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2015
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: RUSD/HARRISON ELEMENTARY SCHOOL-ROOM 3
FACILITY NUMBER: 334843516
VISIT DATE: 08/14/2015
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The facility has enough square footage for the capacity (24) requested.

Limiting factor for capacity (24) will be the Fire Clearance, which is scheduled, but has not been approved.

The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Water fountain next to the sink will supply drinking water in the indoor activity space
· Playground is enclosed by an appropriate fence - Shared with Harrison Elementary
· Outdoor activity area is supplied with age and size appropriate equipment
· An adequate amount of cushioning material (cushioned mat) is in place under play equipment
· Adequate shade is provided by trees
· Drinking water is provided in the outdoor play area by water fountains and water jugs
· Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies - Located on the Harrison Elementary School grounds, but not in the classroom.
· The office area is located at the front entrance of the school and Harrison Elementary School Nurse's office will serve as the isolation area for ill children temporarily until parents arrive
· Staff bathrooms are located on the grounds of Harrison Elementary School
· Medication will be stored in the Harrison Elementary School Nurse's office and is inaccessible to children.
· First Aid kit is complete and inside the classroom
· Sign in/Sign out record was not available for review
· Component II Orientation was completed during the visit
· A review of staff records on 8/14/15 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: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 782-4951
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2015
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: RUSD/HARRISON ELEMENTARY SCHOOL-ROOM 3
FACILITY NUMBER: 334843516
VISIT DATE: 08/14/2015
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Prior to licensure the following areas/documents must be corrected/submitted:

1. Fire Clearance must be granted
2. Copy of Sign in/out sheet must be submitted for review
3. Carbon Monoxide Detector must be installed in the classroom
4. Incidental Medical Services (IMS) Plan must be submitted

Once all corrections have been made, with proof sent to licensing, and the fire clearance has been obtained, 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 may be withdrawn. An exit interview was conducted and a copy of this report was provided to the applicant, Early Childhood Coordinator Joseph Nieto, on this date.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 782-4951
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2015
LIC809 (FAS) - (06/04)
Page: 4 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: RUSD/HARRISON ELEMENTARY SCHOOL-ROOM 3
FACILITY NUMBER: 334843516
VISIT DATE: 08/14/2015
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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 633 - Whenever a Type A deficiency is cited, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 form must be signed by parent/guardian and in children files.
· 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 went into effect January 1, 2012- In accordance with California Health and Safety Code Section 1596.808.
· AB 2109 - Amended Health and Safety Code Section 120365, relating to communicable disease to require an additional form prescribed by the State Department of Public Health (CDPH). This form shall be signed by an authorized health care practitioner and parent or guardian when exempting a child from required immunization(s) due to personal beliefs.
· AB 2236 – Increases the amount of Civil Penalties that may be imposed for a violation that results in death of, or serious bodily injury or physical injury to, client/child.
· AB 2386 – Requires facilities to have one or more functioning Carbon Monoxide detectors.
· AB 2621 – Requires the California Department of Social Services to post licensing information on its website, to be updated at least monthly.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 782-4951
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2015
LIC809 (FAS) - (06/04)
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