Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360910907
Report Date: 07/05/2017
Date Signed 07/05/2017 05:22:04 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:KID'S CLUBFACILITY NUMBER:
360910907
ADMINISTRATOR:ADAMS, CHERIEFACILITY TYPE:
840
ADDRESS:1825 N. VINEYARDTELEPHONE:
(909) 985-7279
CITY:ONTARIOSTATE: CAZIP CODE:
91764
CAPACITY:57CENSUS: 35DATE:
07/05/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:Kristine RamosTIME COMPLETED:
03:30 PM
NARRATIVE
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(3) A required 3 year inspection is being conducted as part of a compliance review. Licensing Program Analyst (LPA), Nelson Zuniga, toured the center, inside and out. The following was observed:
· A review of staff records (those present during this visit) and a review of a sampling of children's records was conducted as part of this evaluation. See Confidential Names List (LIC811)
· The licensee 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
· The facility is operating within the terms of the license, Continue on LIC809C & LIC809D
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2017
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: KID'S CLUB
FACILITY NUMBER: 360910907
VISIT DATE: 07/05/2017
NARRATIVE
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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
· 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 inspections. Continue on LIC809C & LIC809D
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2017
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: KID'S CLUB
FACILITY NUMBER: 360910907
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/05/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/06/2017
Section Cited
101229.1(b)
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Sign In and Sign Out. In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain, and implement a written procedure to sign the child in/out of the child care center The person who brings the child to, and removes the child from, the center shall sign the child in/out.
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Director states that she will provide a plan of correction to the Department by no later than 7/12/2017
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LPA Zuniga observed that children in care are either not being sign in or sign out by the person dropping them off or the person picking them up.
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Type B
07/12/2017
Section Cited
101239(o)(1)
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Fixtures, Furniture, Equipment and Supplies. Playground equipment shall be in safe condition, free of sharp, loose, or pointed parts. LPA Zuniga observed that the paint on the wood poles that hold the climbing structure the paint is chipping this can pose a danger to the children in care. There is also a play car that had the door to the car on the
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Director states that a plan of correction will be sent to the Department by no later than 7/12/17
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ground it appeared that the toy is broken.
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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: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2017
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: KID'S CLUB
FACILITY NUMBER: 360910907
VISIT DATE: 07/05/2017
NARRATIVE
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· Ratios were not met during this visit. During the tour of the facility LPA observed Staff#1 alone in the play yard with 21 school age children. Per Staff#1, the other staff, Staff #2 had step out of the playground for about 5 minutes. A few minutes earlier LPA Zuniga observed Staff#2 in the pre school staff with the 2-3 year old classroom assisting with the children.
· Appropriate supervision was provided during the visit
· Classrooms are equipped with age appropriate furniture and equipment in good condition.
· Classrooms are clean and free of hazards
· All floors shall be kept clean and safe
· No weapons stored at the facility
· 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 when not in use.
· Medications are stored where inaccessible to children
· Hazards are stored where inaccessible to children which includes: 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 not in good condition.
LPA observed that the climbing structure, the wood that holds the structure the paint is chipping and there was a toy car that the door to the car was on the ground broken from toy.
· 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 shall be readily available both indoors and out
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall. Continue on LIC809C & LIC809D
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2017
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: KID'S CLUB
FACILITY NUMBER: 360910907
VISIT DATE: 07/05/2017
NARRATIVE
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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. v Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov. Please subscribe to My CCL on our website. 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, K. Ramos confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.
A NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS ALONG WITH A COPY OF ALL TYPE A DEFICIENCIES (LIC809D/9099D) CITED DURING THIS VISIT. A COPY OF ALL TYPE A DEFICIENCIES CITED DURING THIS VISIT MUST ALSO BE IMMEDIATELY (within 24 hours of the child’s next day in care) GIVEN TO THE PARENTS OF ALL CHILDREN ENROLLED IN THE CHILD CARE FACILITY AND ANY CHILDREN ENROLLED INTO THE CHILD CARE FACILITY OVER THE NEXT 12 MONTHS. Appeal rights were provide and discussed. This report must be available for review, upon request, for the next 3 years. Continue on LIC809D
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2017
LIC809 (FAS) - (06/04)
Page: 5 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: KID'S CLUB
FACILITY NUMBER: 360910907
VISIT DATE: 07/05/2017
NARRATIVE
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· Menus are posted at least one week in advance and kept on file for 30 days
· There is a properly rated Fire extinguisher, smoke detector and carbon monoxide detector in good working order
· Sign in/Sign out record was reviewed and do not meet regulation requirements, children are not being sign in and out see Confidential Name List, LIC811.
· A Staff member is present with current Pediatric CPR/First Aid which expires on 2/23/2019
· Opening and closing staff member’s CPR/First Aid expires on 2/23/2019
· Director completed Health and Safety Training on 01/7/1995
· Children’s records contained a signed copy of the admission agreement
· Staff files contain documentation of the appropriate educational credits
· A review of staff records on 7/5/17 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
· Facility is providing IMS 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 Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.
· 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 . Continue on LIC809C & LIC809D
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2017
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: KID'S CLUB
FACILITY NUMBER: 360910907
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/05/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/06/2017
Section Cited
101516.5(b)(1)
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Teacher-Child Ratio. A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. At the time that LPA Zuniga was conducting the tour of the program. LPA observed Staff #1 listed on Confidential Name List, LIC811., supervising 21 children alone. Per staff #1 she had been alone for 5 minutes A second staff join
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Licensee states that she will provide a plan of correction by no later than 7/6/17
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the class while LPA was talking to Staff #1.
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Type A
07/06/2017
Section Cited
101238(g)
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Buildings and Grounds. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children shall be inaccessible to children. LPA Zuniga observed a tube of Pure Aid Spirit Sunscreen Lotion SPF30 on top of the teacher desk. The Lotion has a warning to keep out of reach of children.
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Director states that she will provide a plan of correction by no later than 7/6/17
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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: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2017
LIC809 (FAS) - (06/04)
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