Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364804037
Report Date: 11/18/2016
Date Signed 11/18/2016 03:40:44 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:WESTSIDE CHRISTIAN PRESCHOOLFACILITY NUMBER:
364804037
ADMINISTRATOR:DEBORAH SORNOSOFACILITY TYPE:
850
ADDRESS:1495 WEST OLIVE STREETTELEPHONE:
(909) 793-5811
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:75CENSUS: 38DATE:
11/18/2016
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Deborah SornosoTIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Joanne Domingo conducted a comprehensive annual visit. A review of a sampling of the staff records and children's records were conducted as part of this evaluation. See Children’s Records Review (LIC857) and Staff Records Review (LIC859)

· 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 licensee 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.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2016
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 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: WESTSIDE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364804037
VISIT DATE: 11/18/2016
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
INCIDENTAL MEDICAL SERVICES PLAN. In accordance with California Health & Safety Code 1597.54(h) - The Incidental Medical Service Plan of Operation includes administering: Blood Glucose Testing, Inhaled Medicines (asthma/bronchitis), Epi-Pen, Glucagon, G-Tube, and/or carrying out Medical Orders.
Incidental Medical Services Plan were discussed with Licensee on this date and time.
Licensee understands that a written Plan of Operation (POO) must be submitted and approved by the Department within 30 days of this report to administer any of the above medications/services to the children in care and shall include: storage of medication and equipment/supplies, and documentation in the children’s, personnel, and administrative records. Please refer to Title 22, Division 12, Chapter 1, Article 03, Regulation 101173(c) Plan of Operation.
INCIDENTAL MEDICAL PLAN ON FILE 10/06/16.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

See LIC809D for cited deficiencies in accordance with the California Code of Regulations Title 22, Division 12.

An exit interview was conducted, Notice of Site Visit posted, Appeal Rights discussed, and a copy of this report was provided to the director, Deborah Sornoso.

The Notice of Site Visit from today’s visit must be posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2016
LIC809 (FAS) - (06/04)
Page: 3 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: WESTSIDE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364804037
VISIT DATE: 11/18/2016
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
· A review of staff records on 11/15/16 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
· The facility representative was advised that 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.

· SB 792 – Day Care Facilities; Immunizations - Effective September 1, 2016, in accordance with California Health & Safety Code 1596.7995 - a person may not be employed or volunteer at a child care center unless he or she has been immunized against influenza (Flu Shot), pertussis (TDAP), and measles or qualifies for an exemption. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
In accordance with California Health & Safety Code 1597.055(a)(5) – all staff in the center must have proof of a tuberculosis clearance.

· 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 Regulations went into effect
January 1, 2012 – In accordance with California Health and Safety Code Section 1596.808 –
Whenever milk is served, serve only low-fat (1 percent) milk or nonfat milk to children two years of age or older. Limit juice to not more than one serving per day of 100 percent juice. Serve no beverages with added sweeteners, either natural or artificial. "Beverages with added sweeteners" does not include infant formula or complete balanced nutritional products designed for children.

· AB 2386 – Carbon Monoxide Detector Regulations went into effect January 1, 2015 – In accordance with California Health and Safety Code Section 1596.954 – 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 Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2016
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: WESTSIDE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 364804037
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2016
Section Cited
H&S 1596.7995
1
2
3
4
5
6
7
STAFF IMMUNIZATIONS:
SB 792 - Day Care Facilities; Immunizations - Effective September 1st, 2016, in accordance with California Health & Safety Code 1596.7995 - a person may not be employed or volunteer at a child care center unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. Missing TDAP: S#1, S#2 & S#4. Missing MMR: S#1, S#2, S#3 & S#4. Missing FLU: S#2, S#3 & S#4.
1
2
3
4
5
6
7
LICENSEE WAS ADVISED TO PROVIDE PROOF OF PERTUSIS (TDAP), MEASLES (MMR), AND FLU VACCINATIONS WITHIN 30 DAYS FOR ALL ADULTS WHOWORK OR VOLUNTEER AT THE CENTER. COPIES OF PROOF OF VACCINATIONS MUST BE RECEIVED ON OR BEFORE 12/19/16.
EMAIL: Joanne.Domingo@dss.ca.gov
FAX: 951-782-4985
MAIL: Riverside Child Care Regional Office, 3737 Main St, Ste 700; Riverside, CA 92501.
8
9
10
11
12
13
14
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2016
LIC809 (FAS) - (06/04)
Page: 4 of 4