Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808719
Report Date: 11/10/2015
Date Signed 11/10/2015 02:09:09 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:AVUSD MARIANA STATE PRESCHOOLFACILITY NUMBER:
364808719
ADMINISTRATOR:BILL CLAYFACILITY TYPE:
850
ADDRESS:10601 MANHASSET ROADTELEPHONE:
(760) 247-7258
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY:48CENSUS: 20DATE:
11/10/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Marlene Vasselenko-Squires and Debora Cornell TIME COMPLETED:
01:30 PM
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A Random Annual (3) visit is being conducted as a compliance review. Licensing Program Analyst (LPA), Joanne Domingo conducted census, reviewed records and toured the center, inside and out. The afternoon class had just started and operates Monday-Friday from 12:15p,-3:15pm. Present during this visit were Lead Teacher, Ms. Vasselenko-Squires, Associate Teacher Ms. Cornell and Ms. Mandy. The following was observed:

· The facility is operating within the terms of the license YES
· Ratios were met during this visit YES
· Appropriate supervision was provided during the visit YES
· Classrooms are equipped with age appropriate furniture and equipment in good condition YES
· Classrooms are clean and free of hazards YES
· No weapons stored at the facility NONE
· Medications are stored where inaccessible to children CURRENTLY THERE ARE NO CHILDREN ON MEDICATION.
· Hazards are stored where inaccessible to children YES
· Storage areas for toxins are locked YES
· All floors are clean and safe YES
· Bathrooms were observed to be safe, sanitary and in operating condition YES
· The facility has one or more functioning carbon monoxide detectors that meet statutory requirements YES
· Playground equipment is in good condition, free from sharp loose or pointed parts YES
· Uncontaminated drinking water is available both inside and out YES
· Area under/around high play equipment, swings, and slides have sufficient cushioning material SAND
· Outdoor activity space surface is maintained in a safe condition and free from hazards YES
· Food preparation, storage areas are clean and free of litter, rubbish and vermin/rodents YES
· Food is stored appropriately and protected from contamination, and contaminated food is discarded immediately YES
· Solid waste storage vessels, including moveable bins, have tight-fitting covers on, are in good repair YES
· All foods/beverages capable of rapid spoiling are stored in covered containers at 45 (F) or less YES
· Menus are posted at least one week in advance, where an authorized representative can view them, are dated and kept on file for 30 days, and are available upon request YES
· Sign in/Sign out record was reviewed and meets regulation requirements, full legal signature YES
SUPERVISOR'S NAME: Marianne DonleyTELEPHONE: (951)782-4200
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2015
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: AVUSD MARIANA STATE PRESCHOOL
FACILITY NUMBER: 364808719
VISIT DATE: 11/10/2015
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· Child’s admission agreement is available for review YES
· Child is signed in and out by the person responsible for the child YES
· Staff member’s CPR/First Aid expires on MVS - 10/16, DC - 9/16.
· A review of staff records contain appropriate documentation of education credits STATE PRESCHOOL.
· A review of staff records on 11/06/15 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. YES

INCIDENTAL MEDICAL SERVICES WERE DISCUSSED. 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.
Licensee has agreed to submit to the Department a written Plan of Operation (POO) 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.

NO DEFICIENCIES CITED DURING THIS VISIT.

· 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) 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 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 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 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.

An exit interview was conducted , Notice of Site Visit posted and a copy of this report was provided to the Lead Teacher, Ms. Marlene Vasselenko-Squires.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Marianne DonleyTELEPHONE: (951)782-4200
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2015
LIC809 (FAS) - (06/04)
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