STATE OF CAL~IFIJJillllmi AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700

RIVERSIDE, CA 92501

This is an official report of an unannounced visiVinvestigation of a complaint received in our office on
06/06/2014 and conducted by Evaluator Aida Aguirre
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20140606133819
FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR: ROBIN CRANDALL
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:
CAPACITY:
40
CENSUS: 12
UNANNOUNCED
MET WITH:
Rohith Senewiratne

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME VISIT BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
07/25/2014
07:45AM
12:00 PM

ALLEGATION(S):
1 Lack of Supervision
2

3
4
5
6
7

8
9
INVESTIGATION FINDINGS:
1 Licensing Program Analysts (LPA's) Nelson Zuniga and Aida Aguirre visited the facility to deliver the findings of
2 the investigation on the above allegations. 101229(a) (1) Care and Supervision. No child(ren) shall be left
3 without the supervision, including visual observation, of a teacher at any time except as specified in sections
4 101216.2(e)(1) and 101230(c)(1). During the investigation interviews were conducted and files were reviewed.
5 It was learned that several of the staff members have used their personal cell phones to talk and text while
6 being the only teacher in the class, supervising children . One staff member was texting while patting a child on
7 the back during nap time. This teacher was also the only teacher in class, who was responsible for supervising
8 the napping children. Based on this information, the allegation is SUBSTANTIATED. Upon receipt, licensee
9 shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and
10 to parents/guardians of children newly enrolled at the facility for the next 12 months. The Notice of Site Visit
11 and Type A Deficiencies from today's visit must be posted for 30 days. Failure to keep these posted for the
12 entire 30 days will result in an immediate $100 civil penalty for each.
13
Estimated Days of Completion:
Substantiated
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Anita Hise
LICENSING EVALUATOR NAME: Aida Aguirre

TELEPHONE: (951) 218-5196

LICENSING EVALUATOR SIGNATURE:

/JJk

~-:-

DATE: 07/25/2014

I acknowledge receipt of this form and understand my appeal rights as explained and received.

DATE: 07/25/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.
UC9099 (FAS) ~ (06/04)

Pago: 1 of 4

 Control Number 09-CC-20140606133819
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

COMPLAINT INVESTIGATION REPORT (Cont)

COLD Regional Oftlc:e, 3737 MAIN ST., SUITE 700

COMMUNITY CARE LICENSING DIVISION
RIVERSIDE, CA 92501

FACILITY NAME: LITILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:

FACILITY NUMBER: 364818120
VISIT DATE: 07/25/2014

Deficiency Type

POC Due Date I

PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

Type A
07/25/2014
Section Cited
101229(a)(1)

1
2
3
4
5
6
7

Care and Supervision. No child(ren) shall be left
without the supervision, Including visual
observation, of a teacher at any time except as

specified In sections 101216.2(e)(1) and
101230(c)(1). During the investigation interviews
were conducted and tiles were reviewed. It was
learned that several of the staff members have

8 used their personal cell phones to talk and text
9 while being the only teacher in the class,
10 supervising children . One staff member was

1
2
3
4
5
6
7
8

12
13
14

9
10
textlng while patting a child on the back during nap 11
12
time. This teacher was also the only teacher in
13
class, who was responsible for supervising the
14
napping children.

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

11

On 7/21/14 the facility implemented a policy stating
that no cell phones shall be allowed in the
c!Eissrooms or working areas. As a POC the faciltiy
has agreed to keep this policy in place and will
provide staff with a copy of the citation.

Failure to correct the cited deliclency(les), on or before the Plan of Correction (POC) due date, may result In
a civil penalty assessment.
SUPERVISOR'S NAME: Anita Hise
TELEPHONE: (951) 782·4200
LICENSING EVALUATOR NAME: Aida Aguirre

TELEPHONE: (951) 218·5196

LICENSING EVALUATOR SIGNATURE:

~ ~..__·

DATE: 07/25/2014

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATtiRE:

/~A~

DATE: 07/25/2014

This Notice must be posted for 30 days
LIC9099 (FAS) · {06/04)

Page: 4 of 4

 STATE OF CALIFORNIA- HEAl-TH AND HUMAN SERVICES AGENCY

CAl-IFORNIA DEPARTMENT OF SOCIAl- SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT (Cont)

CCl-D Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/06/2014 and conducted by Evaluator Aida Aguirre
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20140606133819
FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR: ROBIN CRANDALL
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:
CAPACITY:
40
CENSUS: 12
MET WITH:

Rohith Senewiratne

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
UNANNOUNCED TIME VISIT BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
07/25/2014
07:45AM
12:00 PM

ALLEGATION(S):
1 Food Service
2 License
3 . Physical Plant
4
5
6
7

8
9
INVESTIGATION FINDINGS:
1 Licensing Program Analysts (LPA's) Nelson Zuniga and Aida Aguirre visited the facility to deliver the findings of
2 the investigation on the above allegations.
3
4
During the investigation interviews were conducted and files were reviewed.
5
6 Food Service:
7 An allegation was made that the children are denied seconds. It was learned during the interviews that staff
8 provide as rnany servings as the children ask for, however the children believe they are only allowed to have
9 seconds once and cannot ask for third servings. When asked, the children stated that after they get seconds
10 they are full and cannot eat more than that. Based on that information, there does not appear to be a deficiency
11 pertaining to the Food Service allegation. However because the children believe they are not allowed to have
12 more than two servings, the allegation is not without a reasonable basis. The findings for the Food Service
13 aile ation is INCONCLUSIVE.
Inconclusive
Estimated Days of Completion:

SUPERVISOR'S NAME: Anita Hise

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Aida Aguirre

TELEPHONE: (951) 218-5196

LICENSING EVALUATOR SIGNATURE:

~ ~~---·-

DATE: 07/25/2014

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

cfili. · -- &-

DATE: 07/25/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 {FAS)- (06/04)

Page: 2 of 4

 Control Number 09-CC-20140606133819
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT (Cont)
FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL

CCLO Regional Office,3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120
VISIT DATE: 07/25/2014

NARRATIVE
License:
1
2
An allegation was made that unqualified staff were used to supervise children alone. During the interviews it
3
was learned that Staff 2 was called a "volunteer" but was paid and used as an Aide without units. There is
4
evidence that Staff 2 was used in the classroom to assist staff and cooks for the facility however it could not
be determined what dates and time Staff 2 was in the classrooms and whether Staff 2 was in the classroom
5
6
alone with children. Based on this information, the allegation that there was a License violation is
7
INCONCLUSIVE.
8
9
Physical Plant:
10 An allegation was made that the tables and chairs in the classrooms are dirty. A citation was issued for this
11
violation during a previous visit. LPA's have toured the facility on several occasions and observed that the
12 tables and chairs did not appear to be dirty. However because the facility was previously cited for this
13 violation, the allegation is not without a reasonable basis. The Physical Plant allegation is INCONCLUSIVE.
14
15 This report was discussed and copies provided.
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Anita Hise
LICENSING EVALUATOR NAME: Aida Aguirre

TELEPHONE: (951) 218-5196

LICENSING EVALUATOR SIGNATURE:

~~-·-

DATE: 07/25/2014

1acknowledge receipt of this form and understand my appeal rights as explained and received.
SIGNATURE:
DATE: 07/25/2014

LIC9099 (FAS)- (06/{14)

Page: 3 of 4

 STATE OF

CALIFORNIA~

HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700

RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2014 and conducted by Evaluator Aida Aguirre
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20140528111619
FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
FACILITY NUMBER:
ADMINISTRATOR: ROBIN CRANDALL
FACILITY TYPE:
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
TELEPHONE:
CITY:
SAN BERNARDINO
ZIP CODE:
STATE:
40
CAPACITY:
CENSUS: 12
DATE:
UNANNOUNCED TIME VISIT BEGAN:
MET WITH:
Rohith Senewiratne
TIME COMPLETED:

364818120
850
(909) 882-11 00
92405
07/25/2014
07:45AM
12:00 PM

ALLEGATION(S):
1 Personal Rights

2
3
4
5
6
7

8
9
INVESTIGATION FINDINGS:
1 Licensing Program Analysts (LPA's) Nelson Zuniga and Aida Aguirre visited the facility to deliver the findings of
2 the investigation on the above allegation.
3
4 During the investigation it was learned that an allegation was made that inappropriate discipline was used on
5 Child 1 and that Child 1 alleged that she was inappropriately touched while at the facility. During the
6 investigation files were reviewed and interviews were conducted. It was learned that Child 1 was in care at the
7 facility during the time the allegations were made and Child 1 had been in care by Staff 1 during that time. At
8 this time, it is unclear if the incidents occurred. However because the child and the staff were present at the
9 facility, during the same time, the complaint is not without a reasonable basis. The findings of the investigation
10 are INCONCLUSIVE.
11
12 This report was discussed and copies provided.
13
Inconclusive
SUPERVISOR'S NAME: Anita Hise

Estimated Days of Completion:
TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Aida Aguirre

TELEPHONE: (951) 218-5196

LICENSING EVALUATOR SIGNATURE:

~~-·-

DATE: 07/25/2014

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

~~

Jb<?

DATE: 07/25/2014

This report must be available at Child Care and Group Home facilities tor public review for 3 years.
LIC9099 (FAS) - (06/04)

Page: 1 of 2

 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR ROBIN CRANDALL
ADDRESS:
CITY:
CAPACITY:
TYPE OF VISIT:
MET WITH:

1
2
3
4
5

364818120

FACILITY
NUMBER:
FACILITY TYPE:

2915 N. LITTLE MOUNTAIN DRIVE
TELEPHONE:
SAN BERNARDINO
STATE:CA
ZIP CODE:
40
CENSUS: 12
DATE:
UNANNOUNCED TIME BEGAN:
POC
Rohith Senewiratne
TIME COMPLETED:

850
(909) 882-1100
92405
07/25/2014
07:45AM
12:15 PM

NARRATIVE
Licensing Program Analyst's Nelson Zuniga and Aida Aguirre conducted a plan of correction visit.. This visit
is due to the Case Management visit conducted on 07/23/2014. The facility was cited for Personal Rights
Violation. Today, the licensee provided proof of in service training meeting held with all staff.
At this time the violation is cleared.
An exit interview was held.

6
7
8
9

::&

10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
SUPERVISOR'S NAME: Lya Johnson

TELEPHONE: (951) 782-4216

LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2014

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LICS09 {FASJ- (06/04)

Page: 1 of 1

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
ADMINISTRATOR: ROBIN CRANDALL
ADDRESS:
2915 N. UTILE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:CA
CAPACITY:
40
CENSUS: 14
UNANNOUNCED
TYPE OF VISIT: Case Management- Deficiencies
R. Sevewiratne
MET WITH:

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
07/23/2014
01:49PM
04:00PM

NARRATIVE
1
The following was learned by Licensing Program Analyst (LPA) Nelson Zuniga during the course of a
2
complaint investigation conducted on this date. The following is documented on facility records.
Staff members #1 and #2 were reprimanded because a child's diaper was not changed during nap time.
3
See UC 8090 for deficiency cited.
4
An exit interview was conducted, appeal rights discussed.
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
SUPERVISOR'S NAME: Lya Johnson
TELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 07/23/2014

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

Jl~:ffi

DATE: 07/23/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) • (06/04)

Page: 1 of2

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

COMMUNITY CARE LICENSING OMS ION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

07/25/2014
LITTLE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 07/23/2014, have been cleared:
Section Cited: 101223(a)(2)

Date Due: 07/23/2014

Plan of Correction:

Corrections:
Cleared By Visit

Both employees are no longer employed by the center. Licensee will
have an in service with all staff. Copy of agenda and sign In sheets
are to be sent to the licensing office no later than 07/23/14

LICENSING EVALUATOR NAME: Nelson Zuniga

Clearance Date:
07/25/2014

TELEPHONE: (951) 782·4200

LICENSING EVALUATOR SIGNATURE:

n~t~

DATE: 07/25/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS) • (04/05)

Page: 1 of 1

 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Ftoglonal Otfl~e. 3737 MAIN ST., SUITE
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
ADMINISTRATOR: ROBIN CRANDALL
ADDRESS:
2915 N. UTILE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:CA
CAPACITY:
40
CENSUS: 16
UNANNOUNCED
TYPE OF VISIT: Case Management
ROHITH SENEWIRATNE
MET WITH:

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

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

700

364818120
850
(909) 882-1100
92405
04/23/2014
08:00AM
03:00PM

NARRATIVE
Licensing Program Analyst (LPA) Nelson Zuniga returned to the facility to continue the initial annual visit,
which was initiated on 03/20/14. On this date, a report was giving to the licensee, in the report there were
numerous deficiencies cited. These deficiencies are corrected now.
Moreover, the preschool program is operating in rooms #2, #6, and #8 only.
Rooms #3 and #4 are not used for preschool and for the record are not license preschool rooms.
These two rooms, #3 and #4 are inaccessible to children and are in need of repairs. The Linoleum on floor is
peeling back, the doors to the cabinets are not installed and are on top of the counter, there is debris
scattered throughout the rooms.
LPA Zuniga re-measured rooms #2, #6, and #8 to ensure that the square footage of these rooms could
support the capacity indicated on the license, which is currently 40 preschool children.
The following are the measurements for the rooms.

Indoor activity area measurements:
Classroom 2: 561.06 SQ. FEET.
Classroom 6: 517. 89 SQ. FEET
Classroom 8: 685.73 SQ. FEET
Total indoor activity space: 1764.68 divided by 35 = 50 children

Total children toilets and sinks:

x 15 = 60 children

4 toilets

4 sinks

x 15 = 60 children

Outdoor activity area measurements:
Total outdoor activity space: 5920 divided by 75 = 78 children

Limiting factor for capacity Is 40, per current license. Capacity is limited to 40 children.
Based on current measurements the facility is operating in compliance in terms of the indoor/ outdoor space
available for the children in care.

An exit interview was held with licensee, appeal ri ht discussed.
SUPERVISOR'S NAME: Lya Johnson

TELEPHONE: (951) 782-4216

LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782·4200

LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2014

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LICB09 (FAS) • (06/04)

Page: 1 of 1

 .I
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

STATE OF CALIFORN!Aw HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
ADMINISTRATOR: ROBIN CRANDALL
ADDRESS:
2915 N. UTILE MOUNTAIN DRIVE
SAN BERNARDINO
CITY:
STATE:CA
40
CAPACITY:
CENSUS: 14
UNANNOUNCED
TYPE OF VISIT: Annual/Required
MET WITH:
R. SENEWIRATNE

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
03/20/2014
09:00AM
08:00PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21

Licensing Program Analyst (LPA), Nelson Zuniga and Diana Brasel conducted an
Annual/Required visit. During the tour of the facility LPA observed multiple areas
throughout the pre school areas that were not in compliance, please referred to LIC 809D
where these deficiencies are documented. Also during the tour LPA observed that in rooms
8 which is divided into two room, by a wall with a oversize opening, on one side of the room
there were two staff members supervising 6 children on the other side of the room and out
of view of the two staff members was child #1 by self without direct supervision. Moreover,
the same child receives therapy from a private vendor who is contracted by Inland Empire
Regional Center. During the review of children files, child #1 is missing the agreement
between the parent and the center to have the therapist provide the therapy at the center. No
documentation was found in file.

A review of 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
4. LIC 309 Administrative Organization (only if changes have been made)
22 5. LIC 308 Designation of Administrative Responsibility (only if changes have been made)
23
The following items have been posted and are updated where necessary:
24
Facility License- Facility Menu
25
• Emergency Disaster Plan (LIC61 0) and Earthquake Preparedness Checklist (LIC9148)
• Parent's Rights Poster (PUB393)- Personal Rights (LIC613A)- Child Car Seat Law
• CPR/First Aid Cards - Staff are current - Fire/Disaster Drill Log - Current
CONTINUE ON LIC 809C AND LIC 809D
SUPERVISOR'S NAME: Lya Johnson
TELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2014

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

f2..o t;;;.1 J 2..

DATE: 03/20/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC009 (FAS) (OG/04)
w

Page: 1 of6

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120
VISIT DATE: 03/20/2014

NARRATIVE
1
2
The following civil penalty information was discussed: If a facility is cited for a serious deficiency and then
3
repeats the same violation within a 12 month period, an immediate penalty of $150 shall be assessed and a
4
penalty of $50 per day shall be assessed until the deficiency is corrected. If the facility repeats the same
5
violation for a third time within the same 12 month period, the facility will be cited and assessed an immediate
6
penalty of $150 for that day and $150 per day until the deficiency is corrected. The licensee was advised how
7
to access forms and regulations for Child Care Centers online at www.dss.cahwnet.qov or ccld.ca.gov
8
9
SEE LIC 809D FOR DEFICIENCIES CITED.
10
11
An exit interview was conducted, appeal rights discussed and a copy of this report was provided. Copy of this
12 report must be made available to the public, at the facility site, for 3 years.
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
TELEPHONE: (951) 782-4216
SUPERVISOR'S NAME: Lya Johnson
LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSII\IG EVALUATOR SIGNATURE:
DATE: 03/20/2014

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

cf!k· .

LIC809 (FAS) - (06/04)

A

DATE: 03/20/2014

Page: 2 or 6

 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 03/20/2014

NARRATIVE
1
• The "Notification of Parent's Rights" (PUB393) poster was reviewed and was advised, that it must be posted
2
in an area of the facility accessible to parents.
3
• The licensee was notified that violations of the sections pertaining to Parent's Rights sections
4
101218.1 (b)(8), (c), (d), (e), (e)(1), or (e)(2) are subject to three tier civil penalties.
5
The following was reviewed with the llcensee(s):
6
AB 633- Parent Notification Requirements effective January 1, 2007- Whenever a Type A
7
deficiency
is cited, upon receipt, the licensee shall post and provide copies of this licensing report to
8
parents/guardians of children in care at the facility and to parents/guardians of children newly
9
10 enrolled at the facility during the next 12 months.
11
• AB 978- Zero Tolerance Related Regulations went into effect January 18, 2011 -In
12 accordance with California Health and Safety Code Section 1596.99(c)/1597.58{c)- it was
13 explained that an immediate $150 Civil penalty will be assessed for each serious violation and a civil
14 penalty of $150 per day per violation will be assessed until corrected
15
• AB 2084- Nutritious Beverages in Child Care Facilities effective Januay 1, 2012- was
16
explained
that only low-fat or non-fat milk is to be served to children 2 years of age or older; and
17
18 limit juice to one serving of 100% juice per day; serve no beverages with added sweeteners; and
·
19 water must be available and accessible to children throughout the day.
• A review of staff records on 03/20/14 indicates that all facility staff or other individuals who require
20
caregiver background checks have received criminal record and child abuse index clearances or exemptions.
21
22 • 100.00 Civil Penalty initially for any un-cleared adult, however, as of January 1, 2005, Civil penalty for any
23 un-cleared adult or persons previously cleared through the Department of Social Services not associated to
24 facility, can be up to $500.00 for the first offense and up to $3000.00 for the second offense within a 12 month
25 period.
26
27
• The licensee was advised that the Notice of Site Visit must be posted in an area accessible to parents for a
28 period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must be
29 posted for 30 days.
30
CONTINUE ON LIC 809C AND LIC 809D
31
32
SUPERVISOR'S NAME: Lya Johnson
TELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2014

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2014

LICB09 (FAS)- (06{04)

Page: 3 of 6

 STATE OF CALIFORNIA. HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Aoglonal Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 03/20/2014

DEFICIENCY INFORMATION FOR THIS PAGE:

Deficiency Type
POC Due Date I
Section Number

DEFICIENCIES

PLAN OF CORRECTIONS(POCs)

Type A
03/24/2014
Section Cited
101 238.2(e)

1
2
3
4
5
6
7

1 Ucensee shall provide proof of correction by no
101238.2(e) Outdoor Activity Space. All
2 later than 03/24/2014
playground equipment shall be cushioned with
3
material that will absorb a fall.
4
LPA OBSERVED THE CLIMBING STRUCTURE
5
DOES NOT HAVE SUFFICIENT CUSHIONING
MATERIAL THAT WILL ABSORB A FALL FROM A 6
7
CHILD. THE DIRT IS EXPOSED

Type A
03/21/2014
Section Cited
101238(g)

1
2
3
4
5
6
7

101238(g) Buildings and Grounds. Disinfectants,
cleaning solutions, poisons and other items that ar
dangerous to children shall be inaccessible to
children.
DURING THE TOUR OF FACILITY, IN ROOM 6
THE STAFF HAD HER PERSONAL PURSE
ACCESSIBLE TO THE CHILDREN IN CARE.

1 Ucensee shall conduct an in-service and provide
2 proof to the Licensing by no later than 03/21/2014
3
4
5
6
7

Type A
03/24/2014
Section Cited
101238(1)(a)

1
2
3
4
5
6
7

101238(a)(1) Buildings and Grounds. The
licensee shall take measures to keep the center
free of flies, other insects and rodents.
LPA'S OBSERVED IN THE CHILDREN YARD
UNDER A PIECE OF BOARD, SPIDERS, BLACK
WIDOWS, ANTS, CRICKETS, AND OTHER
MULTIPLE UNIDENTIFIABLE INSECTS.

1 Licensee shall provide proof of correction by no
2 later than 03/24/2014
3
4
5
6
7

Type A
03/21/2014
Section Cited
101 238(d)(2)

1
2
3
4
5
6
7

101238.2(d) Outdoor Activity Space. The surtace
of outdoor activity space shall be maintained in
safe condition. IN THE SOUTH/EAST CORNER
OF THE PLAYGROUND THERE IS A PIECE OF
RE-BAR ROD PROTRUDING NEXT TO A LARGE
HOLE IN THE GROUND THAT IS HAZARDOUS
TO THE CHILDREN IN CARE.

1 Licensee shall provide proof of correction by no
2 later than 03/24/2014
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: Lya Johnson

TELEPHONE: (951) 782-4216

LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2014

").··"J' ••.(-!···

...

•• ·' -.··;·:··. ·-:-·~~., ••• ::•. ..... ••• ~

• --

-

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

C~<.,

..

rv-'

DATE: 03/20/2014

This Notice must be posted for 30 days
LICB09 (FAS)- (06/04)

Page: 4 of 6

_j

 STATE OF

CALIFORNIA~

HEALTH AND HUMAN SERVICES AGENCY

CAUFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office,3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I

FACILITY NUMBER: 364818120
VISIT DATE: 03/20/2014
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

Type A
03/21/2014

Section Cited
10123B(a)

Type A
03/21/2014

Section Cited
101239.1 (c)(2))

1
2
3
4

10123B(a) Buildings and Grounds. The child care

center shall be clean, safe, sanitary and in good
repair at all times.
LPA's OBSERVED IN ROOM BAN AIR UNIT

5 SITIING ON A RUSTED COOKIE SHEET AND

1 LICENSEE SHALL PROVrDE PROOF OF
CORRECTION BY NO LATER THAN 03/21/2014
2
3
4

5

ON A TABLE THAT APPEARS NOT STABLE AND
6
7 NOT ABLE TO SUPPORT THE WEIGHT OF
7
UNIT
6

1
2
3
4

Napping Equipment: Bedding shall 1 LICENSEE SHALL PROVIDE PROOF OF
2 CORRECTION BY NO LATER THAN 03/21/2014
3
4
5 LPA'S OBSERVED IN ROOM BAND 6 CHILDREN 5
6 PERSONAL BELONGING/BEDDING IN CUBBIES, 6
7 HOWEVER, THE BEDDING WAS STICKING
7
101239.1

be individually stored so that each child's bedding
is identifiable and no child's used bedding comes
into contact with other bedding.

B OUT AND THEY WERE TOUCHING THE
9 BEDDING ON THE NEXT CUBBY.
10
11
12
13
14

B LICENSEE SHALL PROVIDE PROOF OF
9 CORRECTION BY NO LATER THAN 03/21/2014
10
11
12
13
14

1
2
3
4

1
2
3
4

5

5

6

6

7

7

Fa1lure to correct the cited deflciency(ies), on or before the Plan of Correction (POC) due date, may result In
a civil penalty assessment.
SUPERVISOR'S NAME: Lya Johnson
TELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2014

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2014

This Notice must be posted for 30 days
LICB09 (FAS) • (06/04)

Page: 5 of 6

 STATE OF CAUFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, ~737 MAIN ST., SUITE 700

COMMUNITY CARE LICENSING DIVISION

RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I
Section Number

Type A
03/21/2014
Section Cited
101229(a)(1)

Type A
03/21/2014
Section Cited

101170(b)(7)

FACILITY NUMBER: 364818120
VISIT DATE: 03/20/2014
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES
1
2
3
4
5
6
7

101229(a)(1) Care and Supervision. No child(ren) 1
2
3
4
as specified in sections 101216.2(e)(1) and
5
101230(c)(1).
6
7

shall be left without the supervision, Including
visual observation, of a teacher at any time except

8
9
10
11
12
13
14

During the tour LPA observed that in rooms 8
which is divided into two room, by a wall with a
oversize opening, on one side of the room there
were two staff members supervising 6 children on
the other side of the room and out of view of the
two staff members was child #1 by self without
direct supervision.

1
2
3
4
5
6
7

CRIMINAL RECORD CLEARANCE: The following
individuals are exempt from the requirement to
submit fingerprints: Employees of a licensed home
health agency who have a contract with a child's
parent or guardian and are in the facility at the
request of that parent or guardian .

8
9
10
11
12
13
14

Child #1 receives therapy from a private vendor
who is contracted by Inland Empire Regional
Center. During the review of children files, child #1
is missing the agreement between the parent and
the center to have the therapist provide the therapy
at the center. No documentation was found in file.

8
9
10
11
12
13
14

Licensee shall conduct an in~service with all staff
and provide proof to the licensing office with sign In
sheets of staff attending in-service and agenda by
no later than 03i21/14

1 No civil penalty will be assess. This is due to the
2 LPA verifying with parent that the parent were the
3 ones to seek the service for child and has made
4 arrangements with the Inland Empire Regional

5 Center to provide the therapy at the center. THE
6 CENTER DOES NOT HAVE DOCUMENTATION
7 ON PARENT/INLAND EMPIRE
8 REGIONAL CENTER/CHILD CARE CENTER
9 CONTRACT IN CHILD'S FILE.
10
11
12
13
14

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 Johnson
TELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2014

I acknowledge receipt of this form and understand my appeal rights as explained and received.

DATE: 03/20/2014

This Notice must be posted for 30 da)is
LIC009 (FAS) - {06/04)

Page: 5 of 5

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

•
.

04/23/2014

.

.

LITILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 03/20/2014, have been cleared:
Section Cited: 101238.2(e)
Plan of Correction:
Licensee shall provide proof of correction by no later than 03/24/2014

Date Due: 03/24/2014
Corrections:
Licensee faxed documentation on
03/24/14 Cleared By Visit

Clearance Date:
04/23/2014

Section Cited: 101238(g)
Plan of Correction:
Licensee shall con duel an In-service and provide proof to the
Licensing by no later than 03/21/2014

Date Due: 03/21/2014
Corrections:
Licensee faxed documentation on
03/24/14 Cleared By Visit

Clearance Date:
04/23/2014

Section Cited: 101238(1)(a)
Plan of Correction:
Licensee shall provide proof of correction by no later than 03/24/2014

Date Due: 03/24/2014
Corrections:
Licensee faxed documentation on
03/24/14 Cleared By Visit

Clearance Date:
04/23/2014

Section Cited: 10123B(d)(2)
Plan of Correction:
Licensee shall provide proof of correction by no later than 03/24/2014

Date Due: 03/21/2014
Corrections:
Licensee faxed documentation on
03/24/14 Cleared By Visit

Clearance Date:
04/23/2014

LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Lotter (FAS) • (04/05)

Page: 1 or 1

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

06/20/2014
LITTLE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 03/20/2014, have been cleared:
Section Cited: 10123B(a)
Plan of Correction:

Date Duo: 03/21/2014
Corrections:

LICENSEE SHALL PROVIDE PROOF OF CORRECTION BY NO
LATER THAN 03/21/2014

Item has been removed from the
children room Cleared By Visit

Section Cited: 101239.1 (c)(2))
Plan of Correctlpn:

Date Due: 03/21/2014
Corrections:
Clearance Date:
Ucensee faxed documentation on
04/.23/2014
03/24/141or the inservice held Cleared

LICENSEE SHALL PROVIDE PROOF OF CORRECTION BY NO
LATER THAN 03/21/2014

Clearance Date:
04/23/2014

By Visit

LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

Yl~t3~

DATE: 06/20/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Lotter (FAS)- (04/05)

Page: 1 of 1

 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING OIVISlON

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

04/23/2014
LITILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 03/20/2014, have been cleared:
Section Cited: 101229(a)(1)
Plan of Correction:

Date Due: 03/21/2014

Corrections:
Licensee fax documentation on
03/24/2014 Cleared By Visit

Section Cited: 101170(b)(7)
Plan of Correction:
No civil penalty will be assess. Thls Is due to the LPA verifying with

Date Due: 03/21/2014
Corrections:
Cleared By Visit

Clearance Date:
04/23/2014

Clearance Date:
04/23/2014

parent that the parent were the ones to seek the service for child and
has made arrangements with the Inland Empire Regional Center to
provide the therapy at the center. THE CENTER DOES NOT HAVE
DOCUMENTATION ON PARENT/INlAND EMPIRE

LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS)- (04!05)

Page: 1 of 1

 STATE OF CALIFORNIA_

HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING OIVISlON
CCLD Regional Office, 3737 MAIN ST., SUITE 700

RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/14/2014 and conducted by Evaluator Nelson Zuniga
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20140314172402
FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
FACILITY NUMBER:
ADMINISTRATOR: ROBIN CRANDALL
FACILITY TYPE:
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
TELEPHONE:
CITY:
SAN BERNARDINO
ZIP CODE:
STATE:
CAPACITY:
40
DATE:
CENSUS: 16
UNANNOUNCED TIME VISIT BEGAN:
MET WITH:
April Dogero
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
04/23/2014
08:00AM
03:00PM

ALLEGATION(S):
1
MEDICATION-The facility withheld adminstrating proper medication
2
3
4
5
6
7

8
9
INVESTIGATION FINDINGS:
1 Licensing Program Analyst (LPA) Nelson Zuniga met with licensee. The allegation was discussed. Facility
2 records were reviewed and staffs were Interviewed. The following is learned.
3 On January 22, 2014 parent of child #1 submitted to the center, via fax, a NEBULIZER CARE
4 CONSENTNERIFICATION FOR CHILD CARE FACILITIES for child #1. In addition, per parent the medicine
5 was provided to the center for the medicine to be administered if needed.
6 LPA interviewed the licensee, per licensee; the parent provided NEBULIZER CARE CONSENTNERIFICATION
7 FOR CHILD CARE FACILITIES but failed to provide the medication for the child.
8 The children file indicate that the NEBULIZER CARE CONSENTNERIFICATION FOR CHILD CARE
9 FACILITIES was signed on 01/22/14 for child #1 and the MEDICAL AUTHORIZATION FORM was signed by
10 parent on 03/1 0/14; which was after the incident date of 03/07/2014.
11 There are conflicting stories. The story told by the accused and that of the accuser are very different. It was
12 said by the accuser that the medicine was brought to the facility before incident of 03/07/14. However, the
13 center stated that the never received an medicine rior to 03/10/14. CONTINUE ON LIC 9099C
Inconclusive
Estimated Days of Completion:
SUPERVISOR'S NAME: Lya Johnson
TELEPHONE: (951) 782-4216

LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2014

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

~

DATE: 04/23/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 {FAS) - (06!04)

Page: 1 of 2

 -{,

Control Number

~~

09-CC-20140314~

STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT (Cont)

CCLD Regional Offlce, 3737 MAIN ST., SUITE 700

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL

AIVERSIOE, CA 92501

FACILITY NUMBER: 364818120
VISIT DATE: 04/23/2014

NARRATIVE

1
2
3
4
5
6
7
8
9

LPA was unable to determine whether the medicine for child was brought in to center to administer prior to
incident. There are no witnesses to corroborate the above allegation. Nor was there enough evidence to
prove the allegation is false therefore, this complaint will be inconclusive at this time on this date.
AN EXIT INTERVIEW WAS CONDUCTED.

10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
SUPERVISOR'S NAME: Lya Johnson

TELEPHONE: (951) 782-4216

LICENSING EVALUATOR NAME: Nelson Zuniga

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2014

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

~Q:J?~
LIC9D99 (FAS) • (06/04)

DATE: 04/23/2014

Page: 2 or 2

 [)]

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CDSS

3737 MAIN ST., SUITE 700

DEPARTMENT OF SOCIAL SERVICES

-

RIVERSIDE, CA 92501

WILL UGHTBOURNE
DIRECTOR

EDMUND G. BROWJN JR.
GOVERNOR

January 17,2014
LITTLE MOUNTAIN PRESCHOOL- 364818120
2419 HEAVENLY WAY
CORONA, CA 92881
Dear Licensee:
This letter is to advise you that a conference has been scheduled for January 22, 2014
at 02:00 PM at the Inland Empire Child Care Office with Nelson Zuniga and Dawn
Parker, Licensing Program Analyst.

Your attendance at this meeting is mandatory. You may bring someone with you to
participate in this meeting (e.g. director, etc.). The conference will focus on the review
of the new application packet submitted on November 20, 2013 to the. Department.

It is requested that you notify our office at (951)782-4200 if date and/or time of
conference requires re-scheduling. Please note that children are not allowed at this
conference.
Since ely:
I

I

I

1 '"'·1
Vt I!\...
[;

\....I

~

Nelso Zuniga
··•.
Licensing Program Analyst
Inland Empire Child Care

 STATE OF CALIFORNIA· HEAl.TH AND HUMk.• ..,ERVICES AGENCY

CALIFORNIA 1..-··ARTMENT OF SOCIAl. SERVICES
COMMUNITY CARE LICENSING DIVISION

NONCOMPLIANCE CONFERENCE SUMMARY PAGE3

CCLO Rogional Qffico, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

NAME AND ADDRESS OF FACILITY:

UTILE MOUNTAIN PRESCHOOL
2915 N. UTILE MOUNTAIN DRIVE
SAN BERNARDINO, CA 92405
FACILITY LICENSE NUMBER:

EFFECTIVE DATE OF LICENSE:

364818120

LICENSE CAPACITY:

02/13/2007

FACILITY TYPE:

STATUS:

3

40

850

LICENSEE NAME(S):

N. LIYANAGE, S. WEERASINGHE, R. & L. SENEWIRATNE
Licensee agreed to do the following in order to bring the facility into compliance no later than the following dates:
1 364818122-INFANT PROGRAM-LICENSED FOR 16
2 08/22/13-Complaint tpCestigation-UMITATIONS ON CAPACITY AND AMBULATORY STATUS-Child under the
3 age of two has been commingled with the preschoolers-. PERSONAL RIGHTS-Child from infant program
4 commingled with preschoolers
5 01/22/13-Annual Random-BUILDINGS AND GROUNDS-Small roaches reported under sink area in infant room.
6 01/22/13-Complaint Investigation-CRIMINAL RECORD CLEARANCE-Staff working at facility prior to being
7 associated

8 DISCUSSED THIS DATE:
9 • Working relationship with Mr. Rohith and licensing should be communicative and professional, respectful
10
and courteous.
11 • Partnership Agreement-Clarification-Role of partners-An updated partnership agreement to be submitted.
12
Updated information needs to be submitted for the partnership. An updated UC 309, Administrative
13
Organization.
14 o A new application/updated information needs to be submitted refiecting current members of partnership.
15 All persons must be fingerprinted, Orientation, UC 215, and all current documents that need to be updated.
16 • Current lease agreement to be submitted by property owners/notarized.
17 o Changes that affect the operation of the facility, must be reported and documentation submitted to the
18
licensing office.
19 • Physical Plant, Supervision, Ratios, Commingling, high staff turnover, Director-discussed. These itema,are,
preventable when he has trained staff to bring to his attention, to be in compliance at all times
·
20
21 • Training-Mr. Senewiratne states that he provides training. An outside vendor will need to provide training to
22
staff.
23 • Physical Plant issues-Maintenance -repairs-Mr. Senewiratne says that he has a maintenance person who
24
comes to repair after hours.
25 • Plan of corrections need to be submitted on date due
26 • Appropriate acceptance of admissions under current plan of operation to meet the needs of the children in
27
care. Appropriate documentation must be submitted to licensing for review, and follow up.
28 • Discussed that changes be made in what has been cited, utilize training with staff, director.
29 • Maintenance log to be kept on file for review.
30 • Child Care Centers Self-Assessment Guide, and Administrative Requirements, Application Booklet, Self
31
-Evaluation. Outside vendor information provided.
32 • Email address to be submitted. The licensing website for information-www.ccld.ca.gov for resources.
LICENSEE SIGNATURE

DATE:

10/01/2013

MANAGER SIGNATURE:

DATE:

10/01/2013

LlC9111 {FAS} -(12J99)-(PUBL1C)

Page: 3 or 4

 STATE OF CALIFORNIA· HEALTH AND HUM,.,. SERVICES AGENCY

CALIFORNIA u~:PARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

NONCOMPLIANCE CONFERENCE SUMMARY PAGE4

CCLO Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

NAME AND ADDRESS OF FACILITY:

LITTLE MOUNTAIN PRESCHOOL
2915 N. LITTLE MOUNTAIN DRIVE
SAN BERNARDINO, CA 92405
FACILITY LICENSE NUMBER:

364818120

EFFECTIVE DATE OF LICENSE:

LICENSE CAPACITY:

0211312007

FACILITY TYPE:

STATUS:

3

40

850

LICENSEE NAME(S):

N. LIYANAGE, S. WEERASINGHE, R. & L. SENEWIRATNE
Licensee has been advised that failure to complete the above agreed upon actions by the dates will result in this
Department taking the following action(s):

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10

11
12

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Il

Licensee agrees to operate the facility in full compliance with Title 22 and Health & Safety Code
requirements with particular attention to the following sections:
• This report shall apply to all three components-Infant (#364818122), Preschool (364818120)
and School age program (364818121)
• Licensee understands that it is licensee's responsibility to know the Title 22 regulations.
• The Department will monitor the licensee's compliance with this plan over the next 24
months to expire on October 1, 2015 to determine if the licensee is able to remain in
compliance with Licensing laws and regulations.
e The licensee understands and acknowledges that the Department, at its discretion, will
make unannounced visits to monitor the compliance of this plan. The license shall submit
a written plan/log to Community Care Licensing on how the physical plant will be
maintained. to prevent these types of violations from occurring in the future. Maintenance
log for review.
• Licensee shall provide staff training from an outside agency. Plan to ensure that staff are
aware of expectations with regards to operation of facility. Training internally to be
submitted within 30 days. Training from an outside/external training to be submitted wihtin
90 days.
" If the Department determines that the licensee has violated the law or regulations in the
future it may refer the facility for revocation or other appropriate administrative action.
• Licensee and staff will receive outside training on basic Title 22 Regulations and submit
proof in writing
" Administrative/Licensee responsibilities, Buildings and Grounds-Physical Plant, Staff
Ratios, Commingling, Responsibility for Providing Care and Supervision, CRIMINAL
RECORD CLEARANCE, Limitations and Capacity and Ambulatory Status to be maintained
" Component I to be attended by licensees and director. All documents must be submitted
for updating of file.
o Discussed steps that licensee will take when not in agreement with deficiencies citedAppeals
e Licensee will submit a written plan to correct the issues discussed on this date with recent
citation as of 09/26/13.
e Application to be submitted by October 15, 2013.
• Plan of corrections to be submitted in a timely manner.
e Licensee shall submit a new application with all current documentation as discussed.
A detailed letter regarding this conference will be mailed to the licensee within 5 calendar days.

LICENSEE SIGNATURE

DATE:

1010112013

MANAGER SIGNATURE:

DATE:

1010112013

  

 

1.109111 - {12199) - (PUBLIC) Page: 4 0M

CALIFORNIA l.-. ARTMENT OF SOCIAL SERVICES

STATE OF CALIFORNIA· HEALTH AND HUMA, ... ERVICES AGENCY

COMMUNITY CARE LICENSING DIVISION

NONCOMPLIANCE CONFERENCE SUMMARY PAGE 2

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

NAME AND ADDRESS OF FACILITY:

UTILE MOUNTAIN PRESCHOOL
2915 N. UTILE MOUNTAIN DRIVE
SAN BERNARDINO, CA 92405
FACILITY LICENSE NUMBER:

364818120

EFFECTNE DATE OF LICENSE:

LICENSE CAPACITY:

02/13/2007

FACILITY TYPE:

STATUS:

3

40

850

LICENSEE NAME(S):

N. LIYANAGE, S. WEERASINGHE, R. & L. SENEWIRATNE
This Noncompliance Conference was called to discuss the following issues or deficiencies:
1 The following is being discussed and will the focus on this date.
2 364818120-PRESCHOOL PROGRAM-LICENSED FOR 40
3 08/23/13-Complaint Investigation-TEACHER-CHILD RATIO-Teachers left with children-out of
4 ratio-commningling-LIMITATIONS ON CAPACITY AND AMBULATORY STATUS-Commingling of school age
5 and infant in preschool-BUILDINGS AND GROUNDS-Areas with roaches
6 06/12/13-Case Management-BUILDINGS AND GROUNDS-Wood pieces in sandbox sagging, slats pieces a
7 hazard
8 06/12/130-Complaint Investigation-BUILDINGS AND GROUNDS-Small bugs/roaches observed and a spider in
9 a classroom in web-OUTDOOR ACTIVITY SPACE-Yard not being maintained-large gopher holes
10 01/22/13-Annual Random-1595.8595 HEALTH and SAFETY CODE-Acknowledgement of Licensing Report not
~~provided to parents-BUILDINGS AND GROUNDS-Swing set non-working-hanging. Toys outside dirty, and a can
or Raid found accessible on cabinet.
13 01/14/13-Case Management-LIMITATIONS ON CAPACITY AND AMBULATORY STATUS-School age
commingled with preschoolers-INDOOR ACTIVITY SPACE-Floors unsafe, and need repair/replacement16 FIXTURES, FURNITURE, EQUIPMENT AND SUPPLIES-Urinal and a bathroom non-functioning-BUILDINGS
AND GROUNDS-Areas in room 3 and 4 are in need of cleaning. Used for storage
,
17
01/14/13-Complaint Investigation-PERSONNEL REQUIREMENTS-Volunteer supervising 18
18
children-OUTDOOR ACTIVITY SPACE-Play yard observed to have slats of wood attached to chain link, with is
19
protruding and splintered
~~ 364818121-SCHOOL AGE PROGRAM LICENSED FOR 24
22 08/23/13-Complaint Investigation-PERSONAL RIGHTS-School age child kept in preschool
23 classsroom-commingled-LIMITATIONS ON CAPACITY AND AMBULATORY STATUS-Child in school age
24 commingled with preschoolers
25 06/12/13-CASE MANAGEMENT-BUILDINGS AND GROUNDS-Rug is in need of cleaning. Exposed wiring
26 observed in classroom. -RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION -One child observed
27 to come into center unsupervised by teacher
28 01/22/13-Annual Random -HEALTH AND SAFETY CODE-1596.8595-Acknowledgement of Licensing Reports
2g not being provided to parents,
30 01/22/13-Complaint Investigation-CRIMINAL RECORD CLEARANCE-Staff not being associated to facility
31 01/14/13-Case Management -LIMITATIONS ON CAPACITY AND AMBULATORY STATUS-Two school age
32 children observed in preschool classroom while preschoolers were napping-commingling./

i:

LICENSEE SIGNATURE

DATE:

10/01/2013

MANAGER SIGNATURE:

DATE:

10/01/2013

LIC9111 (FAS)· (12199) ·(PUBLIC)

Page: 2 of 4

 CAUFORNIA '-~r'ARTMENT OF SOCIAL SERVICES

STATE OF CALIFORNIA~ HEALTH AND HUM...... OERVICES AGENCY

COMMUNITY CARE LICENSING DIVISION

NONCOMPLIANCE CONFERENCE SUMMARY

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

NAME AND ADDRESS OF FACILITY:

UTILE MOUNTAIN PRESCHOOL
2915 N. LITTLE MOUNTAIN DRIVE
SAN BERNARDINO, CA 92405
FACILITY LICENSE NUMBER:

EFFECTIVE DATE OF LICENSE:

364818120

LICENSE CAPACITY:

02113/2007

40

FACILITY TYPE:

STATUS:

3

850

LICENSEE NAME(S).

N. LIYANAGE, S. WEERASINGHE, R. & L. SENEWIRATNE
NAME AND FACILITY NUMBER OF OTHER COMMUNITY CARE, CHILD DAY CARE, RESIDENTIAL CARE
FACILITIES FOR THE ELDERLY, OR HEALTH FACILITIES LICENSED TO OR OWNED BY APPLICANT(S)
WITHIN THE LAST FIVE YEARS.
FACILITY NAME

FACILITY NUMBER

A. LITTLE MOUNTAIN PRESCHOOL
B. LITTLE MOUNAIN PRESCHOOL
C. LITTLE MOUNTAIN PRESCHOOL

364818120
364818121
374818122

D.

E.

F.
DATE OF CONFERENCE:

LICENSING PROGRAM MANAGER:

LICENSING PROGRAM ANALYST:

10/01/2013

MARIANNE DONLEY

Teresa Aguiar

Present at meeting:
NAME

TITLE

REYNAULDO PENNYWELL
MARIANNE DONLEY
TERESA AGUIAR
ROHITH SENEWIRATNE
JAMES WILKERSON
APRIL DOGONARO
ROBIN CRANDALL
ANANDA WEERASINGHE

REGIONAL MANAGER
LICENSING PROGRAM MANAGER
LICENSING PROGRAM ANALYST
LICENSEE
LICENSING PROGRAM ANALYST
PRESCHOOL TEACHER
LEAD TEACHER
HUSBAND TO LICENSEE-SEPAPLI WEERASINGHE

UC9111 (FAS}· (12/99}- (PUBLIC)

Page: 1 of 4

 /
STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT

CCLD Regional Off!c&, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/17/2013 and conducted by Evaluator Teresa Aguiar
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20130917130112
FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DENETRA GRANT
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:
CAPACITY:
40
CENSUS: 34
UNANNOUNCED
ROHITH SENEWIRATNE
MET WITH:

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME VISIT BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
09/25/2013
09:40AM
01:10PM

ALLEGATION(S):
1 PHYSICAL PLANT-Raoches through-out the facility

2
3
4
5
6
7
8
9
INVESTIGATION FINDINGS:
1 Licensing Program Analysts (LPA's) Teresa Aguiar and James Wilkerson conducted a visit and interviewed
2 teachers on 09/19/13. A walk-through of the physical plant observed. On this date, LPA Teresa Aguiar and
3 Eugene Garcia conducted a site visit. A walk-through of the premises done.
4 Census and ratios observed this date. Staff were interviewed and the information that was provided was that
5 they have not seen roaches since the last two to three weeks, which conflicts with the above allegation.

6
7
8
9

Based on the information received, the allegation that there are cockroaches throughout the facility in program
is INCONCLUSIVE at this time.

10 This report shall be made available for review to the public for the next three years.
11 Exit interview conducted with
12
13
Inconclusive
Estimated Days of Completion:
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2013

FACILITY REPRESENTATIVE SIGNATURE:

C££,~

DATE: 09/25/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) • (06/04)

Page: 1 of 2

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AdENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLO Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DENETRA GRANT
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
SAN BERNARDINO
CITY:
STATE:CA
CAPACITY:
40
CENSUS: 34
UNANNOUNCED
TYPE OF VISIT:
Case Management - Other
MET WITH:
Rohith Senewiratne

1
2

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
09/25/2013
09:40AM
01:10PM

NARRATIVE
Licensing Program Analysts (LPA's) Teresa Aguiar and Eugene Garcia conducted a walk through of the
premises.

3
4
5
6
7

During the walk-through of the premises, LPA's observed that there is children's medication to include, three
small 4 ounce bottles of medication accessible to children in the staff lounge refrigerator.
The medication is accessible to children. The staff lounge is open, and the refrigerator is on the counter,
accessible during the visit.

8
9
10
11
Per Title 22, the following shall apply:
12 Exit interview conducted with Mr. Rohith Senewiratne.
13 Appeal rights left at facility.
14 This report shall be made available for review to the public for the next three years.
15
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20
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22
23
24
25
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

)

DATE: 09/25/2013

FACILITY REPRESENTATIVE SIGNATURE:

~~.

DATE: 09/25/2013

[/

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 2

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:

FACILITY NUMBER: 364818120
VISIT DATE: 09/25/2013

Deficiency Type

POC Due Date I

PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

Type A
09/25/2013
Section Cited

101226(e)1)(A)

1 HEALTH RELATED SERVICES
2 In centers where the licensee chooses to handle
3 medications: All prescription and nonprescription

1 Staff break room is currently locked until a locked
2 box is purchased.
3

4 medications shall be centrally stored in accordance 4

5 with the requirements
6 specified below: Medication shall be kept in a
7

5
6
7

8 safe place inaccessible to children.
9 Chidlrens Motrin, pain cold and fever medication

8
9

10 and OM Cough Elixer in the regrigerator
11 accessible. This is a safety hazard to chidlren in
12 care.

10
11
12
13
14

1
2
3

1
2
3
4
5
6
7

13
14

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: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

,

LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2013

FACILITY REPRESENTATIVE SIGNATURE:

-r:

:&Zl-~ ~

DATE: 09/25/2013

This Notice must be posted for 30 days
LIC809 (FAS) • (06104)

Page: 2 of2

 All POC Have Been Cleared
STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CLEARED DEFICIENCIES

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120

FACILITY NAME: LITILE MOUNTAIN PRESCHOOL

VISIT DATE: 09/25/2013
POC Due Date I
Section Number

09/25/2013
101226(e)1 )(A)

1
2

~ ~taff break room is currently locked until a locked box is

5 ~urchased.
6
7
8
9
10
11
12
13
14

Section Cited

Section Cited

Date Cleared I
Comments

PLAN OF CORRECTIONS(POCs)

1
2
3

4

1
2
3
4

1
2
3
4
5
6
7

1
2
3
4

1
2
3
4
5
6
7

1
2
3
4

09/25/2013
Corrected during the visit

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUI~ITY CARE LICENSING DIVISION

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

09/25/2013
UTILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 09/25/2013, have been cleared:
Section Cited: 101226(e)1)(A)

Date Due: 0912512013

Plan of Correction:
Staff break room is currently rocked until a locked box is purchased.

Corrections:
Corrected during the visit

LICENSING EVALUATOR NAME: Teresa Aguiar

-

Clearance Date:

0912512013

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Lotter (FAS)· (04/05)

Page: 1 of 1

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITILE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DENETRA GRANT
ADDRESS:
2915 N. UTILE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:CA
CAPACITY:
40
CENSUS: 22
UNANNOUNCED
TYPE OF VISIT: Case Management - Other
MET WITH:
ROHITH SENEWIRATNE

1
2
3
4

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
07/25/2013
10:00 AM
01:30PM

NARRATIVE
A CASE MANAGEMENT visit was done this date to deliver an AMENDED Civil Penalty report from date of
06/12/13.

5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

~~MJ~f ,_~--

DATE: 07/25/2013

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

4d

-'!

DATE: 07/25/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
UC809 (FAS). (06104)

Page: 1 of 1

 STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Officc1 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DENETRA GRANT
ADDRESS:
2915 N. UTILE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE: CA
CAPACITY:
40
CENSUS: 23
TYPE OF VISIT:
Case Management- Other
UNANNOUNCED
MET WITH:
Denetra Grant

1
2
3
4

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
06/12/2013
02:50PM
07:00PM

NARRATIVE
THIS IS AN AMENDED REPORT FROM VISIT OF 06/12/13. CIVIL PENALTIES WERE APPLIED ON
06/12/13, AND ARE CORRECTED AND COPY LEFT THIS DATE ..
Licensing Program Analysts (LPA's) Teresa Aguiar and Kim Leung conducted a case management visit this
date. During the visit, the following was observed:

5
6
1-Loose wiring against walls in classrooms. Children observed involved in activities where extension chord
7
was plugged in. Two unused outlets were uncovered, unsafe. This is a hazard to children in care.
8
9
2- Wood pieces being used as a roof on sandbox in play area is sagging, and is a hazard to children. Various
10 areas are curved. This is a hazard to children in care. Wood pieces need to be removed, and a large piece of
11
slat wood, on side of fence.
12
13 3-Wooden fence area with rusty nails, and exposed nails, with splintered wood and rusted covered area
14 observed. LPA's observed a rusty nail observed on floor by gate area on cement. This is a hazard to children
15 in care.
16
17 4-Exposed insulation area behind the drinking fountain outside in the playground.
18
19 SEE LIC 809D. APPEAL RIGHTS LEFT AT FACILITY THIS DATE.
20
21
This report shall be made available to the public for the nex1 three years.
22
23
24
25
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa 'Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

<:~'

DATE: 06/12/2013

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

c

.'ie?e~

DATE: 06/12/2013

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 3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:

FACILITY NUMBER: 364818120
VISIT DATE: 06/12/2013

Deficiency Type

POC Due Date I

DEFICIENCIES

PLAN OF CORRECTIONS(POCs)

Section Number

Type A
06/13/2013
Section Cited

101238(a)

Type A
06/13/2013
Section Cited

101238(a)

Type A
06/13/2013
Section Cited

10238(a)

Buildings and Grounds.
Proof of correction to be submitted by due date.
The child care center shall be clean, safe, sanitary 1
2
and in good repair at alt times.
Loose cable against walls in classrooms. Children 3
4
observed involved in activities where extension
5 chord was plugged in. Two unused outlets were
5
6 uncovered, unsafe. This is a hazard to children in 6
7 care.
7

1
2
3
4

1
2
3
4

Buildings and Grounds.
The child care center shall be clean, safe, sanitary
and in good repair at all times
Wood pieces being used as a roof on sandbox in
5 play area is sagging, and is a hazard to children.

1 Proof of correction to be submitted by due date.
2

3
4
5

6
7

6
7

8 Various areas are cuNed. This is a hazard to

9 children in care. Wood pieces need to be removed,
10 and a large piece of slat wood, on side of fence.
11
12
13
14

8
9
10
11
12
13
14

1
2
3
4

1 Proof of correction to be submitted by due date.
2
3
4

Buildings and Grounds.
The child care center shall be clean, safe, Wooded
fence area with rusty nails, and exposed nails, with
splintered wood and rusted covered area observed.
5 LPA's observed a rusty nail observed on floor by
6 gate area on cement. This is a hazard to children
7 in care.

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: Marianne Donley
TELEPHONE: (951) 782-4200
TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Teresa Aguiar
LICENSING EVALUATOR SIGNATURE:

/

rf;;:_.,~.)

DATE: 06/12/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2013

This Notice must be posted for 30 days
LICS09 (FA$} • (06/04)

Page: 2 of 3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I

FACILITY NUMBER: 364818120
VISIT DATE: 06/12/2013
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

Type A
06/13/2013
Section Cited

101238(a)

1 Buildings and Grounds
1 Proof of correction to be submitted by due date.
2 The child care center shall be clean, safe, sanitary 2 This is a repeat violation. Civil Penalties of
3 and in good repair at all times to ensure the safety 3 $150.00 will apply and will continue until corrected.
4 and well-being of children, employees and visitors.
5 Exposed insulation/wiring behind the drinking
6 fountain against the wall outside in the playground
7 has exposed wiring.

4
5

8 This is a safety hazard to children in care. Wood

8

6
7
9

9 pieces are exposed with sharp edges.

10
11
12
13
14

10
11
12
13
14

1
2
3

1
2
3
4

4
5
6
7

5
6
7

1
2
3
4
5
6

1
2
3
4
5
6
7

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: Marianne Donley
TELEPHONE: (951) 782-4200
TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Teresa Aguiar
LICENSING EVALUATOR SIGNATURE:

I

~/b ·= )

DATE: 06/12/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.

DATE: 06/12/2013

This Notice must be posted for 30 days
LICB09 (FAS) • (06/04)

Page: 3 of3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

t

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

IVIL PENALTY ASSESSMENT

~=k\--r'l)<po_, (\-\-z;.<" ~ •u ~ 1
_L£1 ~ J ,G--M\-c. J\1 ().J n ~-_,:~.lx::=_______,
FACILITY ADDRESS

CITY

STATE

8 S:y . ( \;-) C<-Irc.) ·~

LICEN~ED FAblLITY

'-"-------------

ZIP CODE .

_k_&I'C.L\..Q.vi_{~J (.,._.

p:_n/0"::

,-_o_y \,-1-:\ G

'11-LtO_s---

--1-.==

~-<---- ~ ~ (L ==r-CI~TY" 3 \..'-{6' 1 z,.2-o

9u"'ZuJ-,rr.:-Mc__..

Civi_l penalties can be assessed against any facility which fails to take corrective action within prescribed time periods, per
California Health and Safety Code Sections 1548, 1568.0822, 1569.49, 1596.99, and 1597.58. You are hereby notified that a civil
penalty has been assessed.
The above facility has been foun i violation of the California Code of Regulations, Title 22, Divisions 6, and/or 12,
Section(s)
\ 0 \ '- '3
Vi= , •
·
and/or California Health and Safety Code, Division 2, Chapters 3, 3.01, 3.2, 3.4, and 3.5, and 3.6.
Section(s) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

A Licensing Report (LIC 809 or LIC 9099) was issued on , - - - - - - - ; ; - ; ; o ; - - - - - - giving notice that failure to
correct the above violation(s) would result in a civil penalty.
DATE

0 Because you failed to make the corrections specified on the LIC 809, a civil penalty of$.______ is assessed for the
period from

0

K

through - - - - - - - ·
DATE

DATE

A civil penalty of $50 per violation per day, up to a maximum of $150 per violation per day will be assessed. This will
continue until correction(s) is made to comply with the licensing laws, regulations, and approval of the California
Department of Social Services or authorized licensing agency.

Because you repeated a violation of the same subsection within a 12-month Rl'riod, an immediate civil penalty of
$ (.,o'il.oo is assessed for the period from \ o\ ll-\1?>
through ",n\12-\ 13
.
DATE

0

_i

DATE

All Facility Types Except Child Care Centers: Second citation within.a 12 month period; an immediate civil penalty of
$150 per violation; then $50 per day per violation until corrections are made.
Child Care Centers Only: Second citation within a 12-month period; an immediate civil penalty of $150 per violation;
then $150 per day per violation until corrections are made.

0 Residential Care Facility for the Elderly (RCFE), Residential Care Facility' for the Chronically Ill (RCF-CI): Third citation
within a 12-month period; an immediate civil penalty of $1,000 per violation; then $100 per day per violation until
corrections are made.

0

Family Child Care Home (FCCH), Child Care Center (CCC), Community Care Facility (CCF): Third citation within 12month period; an immediate civil penalty of $150 per violation; then $150 per day per violation until corrections are made.

0

FCCH and CCC only: Second or subsequent violation for failure to allow parent or guardian to enter and inspect facility
or for retaliation/discrimination stemming from a request to enter or lodge a complaint. A civil penalty of $50 per violation.
Total Penalty Assessed $
YOU WILL RECEIVE AN INVOICE IN THE MAIL
DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE

.NM'E OF LICENSING PROGRAM ANALYST

\,c 00 , <Qc

 TATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA OEPARIMI:NI U!- l:;tJt:IAL ti!:.HVJGI:::;

:;JVIL PENALTY ASSESSMENr

I

'AGILITY NAME

DATE

Little Mountain Preschool

06/12/2013

AC!LITY ADDRESS

2915 N. Little Mountain Drive
:nv

ZIP CODE

STATE

San Bernardino, CA 92405
~

ICENSEE(S)JOPERATOR

FAC!UTYI;

N. Liyanage, S. Weerasinghe, f(L. Senewiratne

364818120

LICENSED FACILITY
:::ivil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods, per
:::alifornia Health and Safety Code Sections 1548, 1568.0822, 1569.49, 1596.99, and 1597.58. You are hereby notified that a civil
Jenalty has been assessed.
fhe above facility has been found in violation of the California Code of Regulations, Title 22, Divisions 6, and/or 12,
Section(s) _ . 1 J l 1 Z l l l ( o t l . : . . ! l l i k ! l a l . i . = - - - - - - - - - - - - - - - - - - - - - - - - - - - - and/or California Health and Safety Code, Division 2, Chapters 3, 3.01, 3.2, 3.4, and 3.5, and 3.6.
Section(s) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

II, Licensing Report (LIC 809 or LIC 9099) was issued o n - - - - - - - , = - - - - - - giving notice that failure to
:orrect the above violation(s) would result in a civil penalty.
DAre

:::J

Because you failed to make the corrections specified on the LIC 809, a civil penalty of$.______ is assessed for the
period from
through _ _ _ _ _ __
DATE

D

Zl

DATE

A civil penalty of $50 per violation per day, up to a maximum of $150 per violation per day will be assessed. This will
continue until correction(s) is made to comply with the licensing laws, regulations, and approval of the California
Department of Social Services or authorized licensing agency.

Because you repeated a violation of the same subsection within a 12-month period, an immediate civil penalty of
soo oo is assessed for the period from
06112/2013
through
06/1212013

$

DATE

DATE

D

All Facility Types Except Child Care Centers: Second citation within a 12 month period; an immediate civil penalty of
$150 per violation; then $50 per day per violation until corrections are made.

D

Child Care Centers Only: Second citation within a 12-month period; an immediate civil penalty of $150 per violation;
then $150 per day per violation until corrections are made.

D

Residential Care Facility for the Elderly (RCFE), Residential Care Facility for the Chronically Ill (RCF-CI): Third citation
within a 12-month period; an immediate civil penalty of $1,000 per violation; then $100 per day per violation until
corrections are made.

eJ

Family Child Care Home (FCCH), Child Care Center (CCC), Community Care Facility (CCF): Third citation within 12month period; an immediate civil penalty of $150 per violation; then $150 per day per violation until corrections are made.

D

FCCH and CCC only: Second or subsequent violation for failure to allow parent or guardian to enter and inspect facility
or for retaliation/discrimination stemming from a request to enter or lodge a complaint. A civil penalty of $50 per violation.
Total Penalty Assessed $.--'-60-'-0'-'.-'-00-'------YOU WILL RECEIVE AN INVOICE IN THE MAIL.
DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE

IIAME OF liCENSING PROGRAM ANALYST

Teresa Aguiar
SIGNATURE OF LICENSING PROGR M ANALYST

NAME OF FACILITY REPRESENTATIVE/TITLE

 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

08/28/2013
UTILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 06/12/2013, have been cleared:
Section Cited: 101238(a)

Date Due: 06/13/2013

Plan of Correction:

Corrections:

Proof or correction to be submitted by due date. This is a repeat
violation. Civil Penalties or $150.00 will apply and will continue until
corrected.

LICENSING EVALUATOR NAME: Teresa Aguiar

Clearance Date:
Written doc. received 07/25/13. Fax
06/13/2013
rec. notes fax was sent Ia office phone
both times fax was sent-per fax,
cleared 06/13/13

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

c:~

DATE: 08/28/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS)- (04105)

Page: 1 of 1

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORt.IA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

08/28/2013
UTILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 06/12/2013, have been cleared:
Section Cited: 101238(a)

Date Due: 06/1312013

Plan of Correction:

Corrections:

Clearance Date:

Proof of correction to be submitted by due date.

Written doc. received 07125115. Fax

06/13/2013

rec. notes fax sent to office phone both
times fax was sent.-per fax, cleared
06/13113
Section Cited: 101238(a)
Plan of Correction:

Date Due: 06113/2013

Corrections:

Clearance Date:

Written doc. received 07125113. Fax
06/1312013
rec. notes fax sent to office phone both

Proof of correction to be submitted by due date.

times fax was sent-per fax, cleared
06113113
Section Cited: 10238(a)
Plan of Correction:

Date Due: 0611312013

Corrections:

Clearance Date:

Proof of correction to be submitted by due date.

Written doc. received 07125113. Fax

0611312013

rec. notes fax was sent to office phone
both times fax was sent-per fax,
cleared 06113113

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

c:,~

-

DATE: 08/28/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Lotter (FAS) • (04!05)

Page: 1 of 1

 STATE OF CALIFORNIA. HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

08/28/2013
LITTLE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,

The following deficiencies, initially cited during a visit on 06/12/2013, have been cleared:
Section Cited: 101238(a)(1)
Plan of Correction:
Proof of correction to be submitted by due dale.

Date Due: 06/13/2013
Corrections:
Written doc. rec. 07/25/13. Fax rec.
notes fax sent to office phone both
times fax was sent~per fax, cleared
06/13/13

Section Cited: 101238.2(d)(2)
Plan of Correction:
Proof of correction to be submitted by due date.

Date Due: 06/13/2013
Corrections:
Clearance Date:
Written doc. rec. 07/27/13. Fax rec.
06/13/2013
notes fax was sent of office phone both
times fax was sent~per fax, cleared
06/13/13

LICENSING EVALUATOR NAME: Teresa Aguiar

Clearance Date:
06/13/2013

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

4-- .

c:-~:nwo

-

DATE: 08/28/2013

/../

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter {FASJ. (04105)

Page; 1 of 1

 STATE OF CAUFORNlA ~HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE UCENSING DNISION

COMPLAINT INVESTIGATION REPORT

CCLO Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/18/2013 and conducted by Evaluator Teresa Aguiar
COMPLAINT CONTROL NUMBER: 09-CC-20130718144244
FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
FACILITY NUMBER:
ADMINISTRATOR: DENETRA GRANT
FACILITY TYPE:
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
TELEPHONE:
SAN BERNARDINO
STATE:
ZIP CODE:
CITY:
CAPACITY:
40
CENSUS:
DATE:
UNANNOUNCED TIME VISIT BEGAN:

364818120
850
(909) 882-1100
92405
08/23/2013 z_.• 0 {'""·1().4/ AM
\
_!'!M!_!E~T:..!W~I!:!T:.!:!H!;_:-------------------_:T!:!I~M!!§E~C~O~M~P:!L;:!E~T~E~D::_:_ __:~16~.:!;48!!:A~~~Ii1 lA.".'-!."" (?.'-..,..
ALLEGATION(S):
1 1-LICENSE -Out of ratio-One teacher assigned to 33 children while other teacher is out to lunch. This includes
2 one infant child (#1) and school age child (#2)

3
4 2-LIICENSE-COMMINGLING-One infant (child #1-under the age of 2) child has been placed in the preschool
5 and one school age (child #2) child in preschool classroom
6
7 3-PHYSICAL PLANT-Roaches in the preschool by Room 2 and in kitchen area.
8
9
INVESTIGATION FINDINGS:
1 Licensing Program Analysts Teresa Aguiar and James Wilkerson initiated above noted allegation on 07/25/13.
2 Census was taken and ratios were observed. Several teachers interviewed on this date. Not all staff members
3 were not available for interview during this visit.
4 Census and staff ratios observed this date. Several teachers were interviewed this date.\
5 The following is investigated and deliveder with findings this date.
6
7 1-LICENSE -Out of ratio-One teacher assigned to 33 children while other teacher is out to lunch. This includes
8 one infant child (#1) and school age child (#2)
9 Based on interviews, it is reported that at one teacher has been left alone supervisiong up to 33 children, out of
10 ratio, and this includes supervision of one infant child (#1) and one school age child (#2). Teachers are taking,
11 with not enough staff-ratio coverage, and the preschool classroom has had one infant (#1) and one school age
12 child (#2) in classroom.
13 SEE LIC 9099C AND 9099D
Estimated Days of Completion:
Substantiated
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Teresa Aguiar
LICENSING EVALUATOR SIGNATURE:

_....,....._;,.

.....
c~·

-

DATE: 08/23/2013

DATE: 08/2312013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) ~ (06104)

Page: 1 of 2

 Control Number 09-CC-20130718144244
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120
VISIT DATE: 08/23/2013

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
NARRATIVE

1
2
3
4
5
6
7
8
9
10

11
12
13
14
15
16
17
18
19
20
21

22

CONTINUED-PAGE 2
Based on information received, allegation that the classrooms have been Out of ratio-One teacher assigned
up to 33 children while other teacher is on break, and this includes one infant child (#1) and school age child
(#2) in preschool classrooms is SUBSTANTIATED.
2-COMMINGLING-One infant child (#1), under the age of two, has been placed in the preschool and one
school age (#2) child in preschool classroom.
Based on interviews, one child (#1) who is considered an infant has been placed in the preschool classroom
prior to being age 2, to maintain the ratios in the infant classroom. One school age child (#2) has been placed
in the preschool classroom because he is not taken on activities with the school age classroom when the go
on certain outing placing the classroom out of ratio.
Based on the information received, the allegation that one infant child (#1 ), under the age of two, has been
placed in the preschool and one school age (#2) child in preschool classroom on various dates is
SUBSTANTIATED.
3-PHYSICAL PLANT-Roaches in the preschool by Room 2 and in kitchen area.
A walk through of the premises done on 07/25/13 and on this date.
Based on interviews, it is reported that there are roaches in various areas of the preschool.
Roaches are reported to be seen "walking around in various areas of the preschool.
Based on the information received, allegation that there are roaches in the preschool area is
SUBSTANTIATED.
This is a repeat violation, Civil Penalties will apply this date.

23
24
25 SEE LIC 9099D
26 APPEAL RIGHTS LEFT AT FACILITY
27 THIS REPORT SHALL BE MADE AVAILABLE FOR ~EVIEW AT THE (~Cw. FOR THE NEXT TH~EE
~
28 YEARs.
•.
\'\""
c-~
-K> \
1 j.)·-..J c.s,
29
s,~"-"'-"tv·~sv~n:,.::,{lw
V<
•
,.
• cR>
30 Cop~w.l< \l I:><. \<:...f-\- ~ :\1--.,<>:;,~ .~-.\ .F-)"'-"'-TvrVi c..~~' 'v-.l ' \ \ ~ ~""-*""""" \~
31
J
. ,
1
1
32
S.·\e-i'V\.,
\'r~c_i~~<..·\0
M'"'"'-'< V<JJ • '4:-..u.>f"-'<.
SUPER ISOR'S NAME: Marianne Donley
TEL PHONE: (951) 782-4200

._._,__-<

on" \"'ct\

••' ,-

D--> <-

"'"'-1--:>f

J

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2013

cei

of this form and understand my appeal rights as explained and received.
NTATIVE

LIC9099 (FAS)- (06/04)

SIGNAT~RE:
/

.

J

~

DATE: 08/23/2013

Page: 1 of2

 Control Number 09-CC-20130718144244
STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700

RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:

FACILITY NUMBER: 364818120
VISIT DATE: 08/23/2013

Deficiency Type
POC Due Date I
Section Number

Type A
08/23/2013
Section Cited
101216.3(a)

DEFICIENCIES
1
2
3
4
5
6
7

TEACHER CHILD RATIO
There shall be a ratio of one teacher visually
observing and supervising no more than 12
children in attendance, except as specified in (b)
and (c) below.
Interviews conducted reveal that preschool
teachers have been left with up to 33 children

8 at one time, and providing care and supervision to
9 one infant (#1) and one school age (#2) child in
10 preschool classroom causing teacher child ratios to
11 be out of compllance.
12
13
14

Type A
08/23/2013
Section Cited
101161(a)

1
2
3
4
5
6
7

LIMITATIONS ON CAPACITY AND
AMBULATORY STATUS
A licensee shall not operate a child care center
beyond the conditions and limitations specified on
the license, including the capacity limitation.
Children have been commingled in the preschool
classroom. One (#1) infant and one (#2)

8
9
10
11
12
13

school age child have been commingled with the
preschool class. One infant has been commingled
to keep ratios in the infant classroom and the
school age child was in preschool classroom when
he was left behind during certain outdoor activities
were being held with school age classroom.

14

PLAN OF CORRECTIONS(POCs)
1 This shall cease immediatley

2 Written proof of correction to be submitted by due
3 date.
4 An LIC 500, Personnel Sumary Report to be
5 submitted by OB/26/13 with staff hours and duties

6
7
8
9
10
11
12
13
14

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: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2013

FACILITY

REPRESENT~

DATE: 08/23/2013

This Notice must be posted for 30 days
LIC9099 (FAS) • (06104)

Page: 2 of 2

 Control Number 09-CC-20130718144244
STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RNERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I
Section Number

Type A
08/26/2013
.Section Cited
10238(a)(1)

FACILITY NUMBER: 364818120
VISIT DATE: 08/23/2013
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES
1
2
3
4
5
6
7

BUilDINGS AND GROUNDS
The child care center shall be clean, safe, sanitary
and in good repair at all times to ensure the safety
and well~being of children, employees and visitors.
The licensee shall take measures to keep the
center free of flies, other insects, and

1
2
3
4
5
6
7

Proof of correction to be submitted by due date.
This is a repeat violation. CIVIL PENALTIES WILL
APPLY AND WILL CONTINUE UNTIL PROOF OF
CORRECTION IS SUBMITTED .

8
8 rodents.
9 Based on interviews conducted, the preschool has 9
10 areas with roaches that have been observed.
10
11
11
12
12
13
13
14
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 m
a civil penalty assessment
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 08/2312013

I acknowle

fonm and understand my appeal rights as explained and received.
NATURE:

--

__./-_{__.)--'-"
-~---

DATE: 08/23/2013

This Notice must be posted for 30 days
LIC0099 (FAS)- (06/04)

Page: 2 of 2

 STATE OF CALIFORNIA· HEALTH AND HutMN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

CIVIL PENALTY ASSESSMENT
FACIUTYNAME

rnomATE;;------------------

Gm'L_ i'Jio_;"-\zc:--. {c.L-sdJ...M \

\?

FACIUTY ADDRESS

8'J 2-3 \13

L,S IS: l.,j . ~\':h c,. fv\a-'.--d--.,,..., ) (
CI1Y_

:ZIPCOOE

STATE

_)''-""--~V0?\.""\\10-Q,_So- ~02:\....\..o~-----

UCENSEE(SifOPERATOR

jJ, L.'"'"'"""-c.~.S)~Jc~~ ''51--.'-r
LICENSED FACILITY

-

l

'l::-_.f-_ _ _

f.<_ __

---

FACILITY I

..)<.I'>(..W ~ """-~'--'

----~--~---·--

3~'-l8 1 '8_\l-O

Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods, per
California Health and Safety Code Sections 1548, 1568.0822, 1569.49, 1596.99, and 1597.58. You are hereby notified that a civil
penalty has been assessed.
The above facility has been found in viol§ltion of the California Code of Regulations, Title 22, Divisions 6, and/or 12,
Section(s)
2. ?-,
Cc-) '-1 ')
and/or California Health and Safety Code, Division 2, Chapters 3, 3.01, 3.2, 3.4, and 3.5, and 3.6.
Section(s) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

\0

o

A Licensing Report (LIC 809 or LIC 9099) was issued o n , . . - - - - - - - ; = - - - - - - giving notice that failure to
"'''
correct the above violation(s) would result in a civil penalty.

0

Because you failed to make the corrections specified on the LIC 809, a civil penalty of$______ is assessed for the
period from
through - - - - - - - ·

0

DATE

DATE

A civil penalty of $50 per violation per day, up to a maximum of $150 per violation per day will be assessed. This will
continue until correction(s) is made to comply with the licensing laws, regulations, and approval of the California
Department of Social Services or authorized licensing agency.

~ Because you repeated a violation of the same subsection within a 12-month period~~n immediate civil penalty of
$ l :512 ,\9-0 is assessed for the period from 0 8\ ;) 3 I 1=?,
through G ..Q \ :2.3\ 13'
.
'

!/()

.

.

DATE

DATE

All Facility Types Except Child Care Centers: Second citation within a 12 month period; an immediate civil penalty of
$150 per violation; then $50 per day per violation until corrections are made.

0

Child Care Centers Only: Second citation within a 12-month period; an immediate civil penalty of $150 per violation;
then $150 per day per violation until corrections are made.

0

Residential Care Facility for the Elderly (RCFE), Residential Care Facility for the Chronically Ill (RCF-CI): Third citation
within a 12-month period; an immediate civil penalty of $1,000 per violation; then $100 per day per violation until
corrections are made.

0

Family Child Care Home (FCCH), Child Care Center (CCC), Community Care Facility (CCF): Third citation within 12·
month period; an immediate civil penalty of $150 per violation; then $150 per day per violation until corrections are made.

0

FCCH and CCC only: Second or subsequent violation for failure to allow parent or guardian to enter and inspect facility
or for retaliation/discrimination stemming from a request to enter or lodge a complaint. A civil penalty of $50 per violation.
Total Penalty Assessed $ \
YOU WILL RECEIVE AN INVOICE IN THE MAIL.
DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE

·-r

---J-=('r_~c;>c:_:/\~ ,__.)

;:_o_cr--..---~----_-----f-.)1;;;;1}.;1#-.!;J;t(_~

SIGNATURE OF LICENSING PAOGRM1 ANALYST

- - - - - - - 1 TITLE

uc 421

(7/11)

5'"D ., 0 :J

 STATE OF CALIFORNIA. HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLO Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DENETRA GRANT
ADDRESS:
2915 N. UTILE MOUNTAIN DRIVE
SAN BERNARDINO
CITY:
STATE:CA
CAPACITY:
40
CENSUS: 22
UNANNOUNCED
Case Management- Other
TYPE OF VISIT:
MET WITH:
ROHITH SENEWIRATNE

1
2

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
07/25/2013
10:00 AM
01:30PM

NARRATIVE
A CASE MANAGEMENT visit was done this date to deliver an AMENDED Civil Penalty report from date of
06/12/13.

3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

~~MJ~f ,~--

DATE: 07/25/2013

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

4d~~'!

DATE: 07/25/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LICB09 (FAS) • JOG/04)

Page: 1 or 1

 STATE OF CALIFOANlA • HEAL1li AND HUMAN SERVICES AGENCY

CAUFORNIA DEPARTMENT OF SOCIAL SERVICES

CIVIL PENALTY ASSESSMENT
FAC!UTY NAME

k\--r:J\_<:,__JAo..; ('-~t<" ~r{j ~

I

FACIUTY ADDRESS

-~-~LS:::
CITY

tJ )-•:.m-e.. MoJ..,htz_,.., vr:::::-___ ·=----l
STATE

ZIP CODE

. . J~a-.Q.~.\..e.-.

p_:G:';:" 'i-~ ~ .s:W

"tl..-<...t<l.:s::-

(<.He)

--.

iL =r'•c•LriY• _3 i..'-l13i {5 I
1u.-u ·, rc.:tr-,
(.__..

·~~h-<-- ~a_

LICENSED FA'CILITV:S l_y-.,

..

)..o ___ _

Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods, per
California Health and Safety Code Sections 1548, 1568.0822, 1569.49, 1596.99, and 1597.58. You are hereby notified that a civil
penalty has been assessed.
The above facility has been faun i violation of the California Code of Regulations, Title 22, Divisions 6, and/or 12,
Section(s)
\0\L.-'3
vi""
'
and/or California Health and Safety Code, Division 2, Chapters 3, 3.01, 3.2, 3.4, and 3.5, and 3.6.
Sectron(s) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

A Licensing Report (LIC 809 or LJC 9099) was issued on -------==-_____ giving notice that failure to
correct the above violation(s) would result in a civil penalty.
DATE

0

Because you failed to make the corrections specified on the LJC 809, a civil penalty of$. ______ is assessed for the
period from
through - - - - - - -

0

R

DATE

DATE

A civil penalty of $50 per violation per day, up to a maximum of $150 per violation per day will be assessed. Th.is will
continue until correction(s) is made to comply with the licensing Jaws, regulations, and approval of the California
Department of Social Services or authorized licensing agency.

Because you repeated a violation of the same subsection within a 12-month R:Sriod, an immediate civil penalty of
$ (gQ'U .oo is assessed for the period from \ o \ \7...\\3•
through~ 2.\

\I

0

~

DATE

13

.

DATE

All Facility Types Except Child Care Centers: Second citation within.a 12 month period; an immediate civil penalty of
$150 per violation; then $50 per day per violation until corrections are made.
Child Care Centers Only: Second citation within a 12-month period; an immediate civil penalty of $150 per violation;
then $150 per day per violation until corrections are made.

0

Residential Care Facility for the Elderly (RCFE), Residential Care Facility' for the Chronically Ill (RCF-CI): Third citation
within a 12-month period; an immediate civil penalty of $1 ,000 per violation; then $100 per day per violation until
corrections are made.

0

Family Child Care Home (FCCH), Child Care Center (CCC), Community Care Facility (CCF): Third citation within 12month period; an immediate civil penalty of $150 per violation; then $150 per day per violation until corrections are made.

0

FCCH and CCC only: Second or subsequent violation for failure to allow parent or guardian to enter and inspect facility
or for retaliation/discrimination stemming from a request to enter or lodge a complaint. A civil penalty of $50 per violation.

Total Penalty Assessed $
YOU WILL RECEIVE AN INVOICE IN THE MAIL.
DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE
NAME OF LICENSING PROGRAM ANAlYST

UC421 (7/11)

NAME OF FACILITY REPRESENTATIVEIT11LE

\,p Q 0 " 0

<:>

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DENETRA GRANT
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:CA
CAPACITY:
40
CENSUS: 23
UNANNOUNCED
TYPE OF VISIT:
Case Management- Other
MET WITH:
Denetra Grant

1
2

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
06/12/2013
02:50PM
07:00PM

NARRATIVE
Licensing Program Analysts (LPA's) Teresa Aguiar and Kim Leung conducted a case management visit this
date. During the visit, the following was observed:

3
4
5

1-Loose wiring against walls in classrooms. Children observed involved in activities where extension chord
was plugged in. Two unused outlets were uncovered, unsafe. This is a hazard to children in care.

6
7
2- Wood pieces being used as a roof on sandbox in play area is sagging, and is a hazard to children. Various
8
areas are curved. This is a hazard to children in care. Wood pieces need to be removed, and a large piece of
9
slat wood, on side offence.
10
11
3-Wooden fence area with rusty nails, and exposed nails, with splintered wood and rusted covered area
12 observed. LPA's observed a rusty nail observed on floor by gate area on cement. This is a hazard to children
13 in care.
14
15 4-Exposed insulation area behind the drinking fountain outside in the playground.
16
17 SEE LIC 809D. APPEAL RIGHTS LEFT AT FACILITY THIS DATE.
18
19 This report shall be made available to the public for the next three years.
20
21
22
23
24
25
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

eX'

~1/~

DATE: 06/12/2013

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

JU

DATE: 06/12/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
UC809 {FAS) • (OG/04)

Page: 1 of 3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92!01

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:

FACILITY NUMBER: 364818120
VISIT DATE: 06/12/2013

Deficiency Type
POC Due Date I
Section Number

DEFICIENCIES

Buildings and Grounds.
Proof of correction to be submitted by due date.
The child care center shall be clean, safe, sanitary 1
2
and in good repair at all times.
Loose cable against walls in classrooms. Children 3
4
observed involved in activities where extension
5
chord was plugged in. Two unused outlets were
6
uncovered, unsafe. This is a hazard to children in
7 care.
7

101238(a)

1
2
3
4
5
6

Type A
0611312013

1
2
3
4

Type A
0611312013
Section Cited

Section Cited

101238(a)

PLAN OF CORRECTIONS(POCs)

1 Proof of correction to be submitted by due date.
Buildings and Grounds.
The child care center shall be clean, safe, sanitary 2
3
and in good repair at all times
4
Wood pieces being used as a roof on sandbox in
5 play area is sagging. and is a hazard to children.
5

6
7

6
7

8
8 Various areas are curved. This is a hazard to
9 children in care Wood pieces need to be removed, 9
10
10 and a large piece of slat wood, on side of fence.
11
11
12
12
13
13
14
14

Type A
06113/2013
Section Cited

10238(a)

1
2
3
4

Buildings and Grounds.
The child care center shall be clean, safe, Wooded
fence area with rusty nails, and exposed nails, with
splintered wood and rusted covered area observed.
5 LPA's observed a rusty nail observed on floor by
6 gate area on cement. This is a hazard to children
7 in care.

1 Proof of correction to be submitted by due date.
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: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

/G

DATE: 06/12/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2013

This Notice must be posted for 30 days
LIC609 {FAS) • (06104)

Page: 2 of 3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 925111

FACILITY NAME: LITILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I

FACILITY NUMBER: 364818120
VISIT DATE: 06/12/2013

DEFICIENCIES

PLAN OF CORRECTIONS(POCs)

Section Number

Type A
06113/2013
Section Cited

101238(a)

1
2
3
4
5
6
7

Buildings and Grounds
The child care center shall be clean, safe, sanitary
and in good repair at all times to ensure the safety
and well-being of children, employees and visitors.
Exposed insulation/wiring behind the drinking
fountain against the wall outside in the playground
has exposed wiring.

1 Proof of correcticn to be submitted by due date.
2 This is a repeat violation. Civil Penalties of
3 $150.00 will apply and will continue until corrected.
4
5
6
7
8

8 This is a safety hazard to children in care. Wood
9 pieces are exposed with sharp edges.

9

10
11
12
13
14

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: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar
LICENSING EVALUATOR SIGNATURE:

~/6

TELEPHONE: (951) 782-4200

....

I

)

DATE: 06/12/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2013

This Notice must be posted for 30 days
LIC809 !FAS) • (06104)

Page: 3 of 3

 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

CIVIL PENALTY ASSESSMENT

IDATE

FACILITY NAME

Little Mountain Preschool

06/12/2013

=AGILITY ADDRESS

2915 N. Little Mountain Drive
::ITY

STATE

ZIP CODE

San Bernardino, CA 92405

....r.:-

JCENSEE{S)/OPERATOR

N. Liyanage, S. Weerasinghe,

FACILITY II;

RJ..L Senewiratne

364818120

LICENSED FACILITY
Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods, per
California Health and Safety Code Sections 1548, 1568.0822, 1569.49, 1596.99, and 1597.58. You are hereby notified that a civil
penalty has been assessed.
The above facility has been found in violation of the California Code of Regulations, Title 22, Divisions 6, and/or 12,
Section(s) _ j _ ( l 1 Z l a ( < l ) . . = . . ! l l l k l l a l i = - - - - - - - - - - - - - - - - - - - - - - - - - - - - and/or California Health and Safety Code, Division 2, Chapters 3, 3.01, 3.2, 3.4, and 3.5, and 3.6.
Section(s) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

A Licensing Report (LIC 809 or LIC 9099) was issued on --------;;:=-_ _ _ _ _ giving notice that failure to
:orrect the above violation(s) would result in a civil penalty.
DATE

::J Because you failed to make the corrections specified on the LIC 809, a civil penalty of$.______ is assessed for the
through _ _ _ _ _ __

period from
DATE

DATE

D A civil penalty of $50 per violation per day, up to a maximum of $150 per violation per day will be assessed. This will
continue until correction(s) is made to comply with the licensing laws, regulations, and approval of the California
Department of Social Services or authorized licensing agency.

Zl

Because you repeated a violation of the same subsection within a 12-month period, an immediate civil penalty of
$
600 oo is assessed for the period from
06/12/2013
through
06/12/2013
DATE

DATE

D

All Facility Types Except Child Care Centers: Second citation within a 12 month period; an immediate civil penalty of
$150 per violation; then $50 per day per violation until corrections are made.

D

Child Care Centers Only: Second citation within a 12-month period; an immediate civil penalty of $150 per violation;
then $150 per day per violation until corrections are made.

D

Residential Care Facility for the Elderly (RCFE), Residential Care Facility for the Chronically Ill (RCF-CI): Third citation
within a 12-month period; an immediate civil penalty of $1,000 per violation; then $100 per day per violation until
corrections are made.

ll

Family Child Care Home (FCCH), Child Care Center (CCC), Community Care Facility (CCF): Third citation within 12month period; an immediate civil penalty of $150 per violation; then $150 per day per violation until corrections are made.

D

FCCH and CCC only: Second or subsequent violation for failure to allow parent or guardian to enter and inspect facility
or for retaliation/discrimination stemming from a request to enter or lodge a complaint. A civil penalty of $50 per violation.
Total Penalty Assessed $._:::60:::0:.:..0:::0::.__ _ _ __
YOU WILL RECEIVE AN INVOICE IN THE MAIL.
DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE

MME OF LICENSING PROGRAM ANALYST

NAME OF FACILITY REPRESENTATIVEfflTLE

Teresa Aguiar
31GNATURE OF LICENSING PROGR M ANALYST

DATE

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visiUinvestigation of a complaint received in our office on
06/04/2013 and conducted by Evaluator Teresa Aguiar
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20130604163737
FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DENETRA GRANT
ADDRESS:
2915 N. LITILE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:
CAPACITY:
40
CENSUS: 23
UNANNOUNCED
DENETRA GRANT
MET WITH:

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME VISIT BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
06/12/2013
02:50PM
07:00PM

ALLEGATtON(S):
1 Building and Grounds
2 1-roaches, spiders and other bugs in the facility, some were dead
3 2-play area is full of gaffer holes
4

5
6
7
8
9
INVESTIGATION FINDINGS:
1 Licensing Program Analysts (LPA's) Teresa Aguiar and Kim Leung conducted a visit this date to initiate and
2 investigate above noted allegations.
3 A walk-through of the premises done inside and outside of the facility; census taken, and ratios noted.
4
5 1-During the walk-through of the premises, LPA's observed bugs/small roaches that were dead spread out in
6 various classrooms. Spider webs noted on the wall in one classroom with a spider. Allegation that there are
7 roaches, spiders, and other bugs in the facility, some were dead is SUBSTANTIATED.
8
9 2-Piay area outside in play yard noted to have gopher holes that are in various sizes and depth. Observable
10 holes noted, and it was confirmed that there are gophers in the yard, and the holes are covered with dirt in
11 those areas. Allegation that the play area is full of gopher holes is SUBSTANTIATED this date.
12 SEE ATIACHED. APPEAL RIGHTS LEFT AT FACILITY. SEE LIC 9099D.
13 This report shall be made available to the public for review for the next three years.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Marianne Donley
TELEPHONE: (951) 782-4200
TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Teresa Aguiar
LICENSING EVALUATOR SIGNATURE:

~kl

.

DATE: 06/12/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

(j/

DATE: 06/12/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
UC9099 (FAS)· (06/04)

Page: 1 of 3

 Control Number 09-CC-20130604163737
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT (Cont)

CCLO Regional Offico, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I

FACILITY NUMBER: 364818120
VISIT DATE: 06/12/2013
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

Type A
06/13/2013
Section Cited

101238(a)(1)

1
2
3
4
5
6
7

Buildings and Grounds.
The licensee shall take measures to keep the
center free of flies, other insects and rodents.
During the walkwthrough of the premises, LPA's
observed bugs/small roaches that were dead
spread out in various classrooms. Spider webs
noted on the wall in one classroom with a spider.

8 roaches, spiders, and other bugs in the facility,
9 some were dead are observed this date in
10 classrooms. This is a hazard to children in care.

11
12
13
14

Type A
06/13/2013
Section Cited

101238.2(d)(2)

1 Proof of correction to be submitted by due date.
2
3
4
5
6
7
8
9
10
11
12
13
14

1
2
3
4
5
6
7

Outdoor Activity Space.
The surface of the outdoor activity space shall be
maintained: Free of hazards including, but not
limited to, holes, broken glass and other debris,
and dry grasses that pose a fire hazard. Play area
outside in play yard noted to have gopher holes
that are in various sizes and depth.

1 Proof of correction to be submitted by due date.
2
3
4

8
9
10
11
12
13
14

Observable holes noted, and it was confirmed that 8
9
there are gophers in the yard, and the holes are
covered with soft dirt in those areas, with uneven 10
11
surfaces which is a hazard to children in care.

5
6
7

12
13
14

Failure to correct the cited deficiency(ies), on or before the Plan of CorrectiOn (POC) due date, may result m
a civil penalty assessment.
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

.

~~
r~
1

DATE: 06/12/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.

DATE: 06/12/2013

This Notice must be posted for 30 days
LIC9099 (FAS) • {06/04)

Page: 2 of3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLO Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
FACILITY NUMBER:
ADMINISTRATOR:DENETRA GRANT
FACILITY TYPE:
ADDRESS:
2915 N. LITILE MOUNTAIN DRIVE
TELEPHONE:
CITY:
SAN BERNARDINO
STATE:CA
ZIP CODE:
CAPACITY:
40
CENSUS: 25
DATE:
UNANNOUNCED TIME BEGAN:
TYPE OF VISIT: Case Management - Other
MET WITH:
Elizabeth York
TIME COMPLETED:

1
2
3
4
5
6
7
8

364818120
850
(909) 882-1100
92405
05/09/2013
02:45PM
04:10PM

NARRATIVE
Licensing Program Analysts (LPA's) Teresa Aguiar and Kim Leung conducted a site visit to measure all
classrooms on the premies, to include: infant room, preschool classrooms, and school age classes.
Census was taken infants-4, preschool-25, school age -0
During this visit, licensee is being advised that paper towels, toilet paper, and soap shall be made available
within children's reach for sanitary purposes.
All bathrooms/urinals shall be kept in working order at all times.
LPA will calculate current measurements and make contact with Director for follow up.

9
10 A current facility sketch needs to be submitted to include the hallw?ys that separate the classrooms.
11
12
13 Exit interview conducted with Elizabeth York and delivered to Denetra Grant upon arrival.
14 This report shall be made available for the next three years.
15
16
17
18
19
20
21
22
23
24
25
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

/~

DATE: 05/09/2013

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

~.

DATE: 05/09/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
UC809 (FAS) • (06f04)

Page: 1 of 1

 STATE OF CALIFORNIA. HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLO Roglonal Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92601

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
FACILITY NUMBER:
ADMINISTRATOR:DENETRA GRANT
FACILITY TYPE:
ADDRESS:
2915 N. UTILE MOUNTAIN DRIVE
TELEPHONE:
SAN BERNARDINO
STATE: CA
CITY:
ZIP CODE:
CAPACITY:
40
CENSUS: 11
DATE:
TYPE OF VISIT: Case Management- Other
UNANNOUNCED TIME BEGAN:
MET WITH:
DEMETRIA GRANT/GLORIA DORADO
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
04/24/2013
02:15PM
03:45PM

NARRATIVE
1

Licensing Program Analyst Teresa Aguiar conducted a case management visit this
date.
Census taken this date.
Census for infants-2, School age-0, Preschool-23

2
3
4
5
6

7
8
During visit, it is noted that various changes will be made and have been made to
9
sketch. A further review of previous reports/history will need to be done to see if
10
changes will reflect capacity and measurements. Review of facility sketch and a
11
12 walk through done of the premises inside. Upon review, LPA Aguiar will return to
13
continue visit.
14
15
16
17
18
19
20 Exit interview conducted with Rohith Senewiratne.
21
22 This report shall be made available for review to the public for the next three
23 years.
24
25
SUPERVISOR'S NAME: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

~

DATE: 04/24/2013

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

......

~~~

DATE: 04/24/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LJC809 (FAS) • (06/04)

Page: 1 of 1

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

03/19/2013
UTILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881
Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 03/13/2013, have been cleared:
Section Cited: 101212(e)(4)
Plan of Correction:
Proof of correction to be submitted by due date.

Date Du~: 03/1 B/2013
Corrections:
corrected 03/18/2013.

Clearance Date:
03/18/2013

Classrooms specified during preticensig inspection shall be utilized
for each specific program, unless requested in writing prior to
changes, and approval from the licensing office has been received.

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

~

DATE: 03/19/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS)· (04{05)

Page: 1 of 1

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DENETRA GRANT
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
SAN BERNARDINO
STATE:CA
CITY:
CAPACITY:
40
CENSUS: 8
UNANNOUNCED
POC
TYPE OF VISIT:
MET WITH:
Denetra Grant

1
2
3
4
5
6
7

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
03/19/2013
04:50PM
05:50PM

NARRATIVE
Licensing Program Analyst (LPA) Teresa Aguiar conducted a PLAN OF CORRECTION visit this date.
LPA Aguiar was provided information that was submitted to the licensing office via fax. LPA reviewed copy of
information submitted to the office.
At this time, the Arts & Crafts room will not be utilized by children.
Classrooms specified during prelicensig inspection shall be utilized for each specific program, until requested
in writing prior to changes, and approval from the licensing office has been received.

8
9
10
11
12
13 Exit interview conducted with Denetra Grant.
14 This report shall be made available for review to the public for the next three years.
15
16
17
18
19
20
21
22
23
24
25
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa Aguiar

-

LICENSING EVALUATOR SIGNATURE:

---

TELEPHONE: (951) 782-4200

DATE: 03/19/2013

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

Kd

DATE: 03/19/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LICB09 {FAS) ~ (06/04)

Page: 1 of 1

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITILE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DENETRA GRANT
ADDRESS:
2915 N. LITILE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:CA
CAPACITY:
40
CENSUS: 22
UNANNOUNCED
TYPE OF VISIT: Case Management - Other
MET WITH:
DENETRA GRANT

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
03/13/2013
11:40AM
02:55PM

3

NARRATIVE
Licensing Program Analyst Teresa Aguiar conducted a site visit this date. Discussed this date rooms and
usage of rooms on the premises. During the visit, LPA Aguiar was asked about rooms being utilized for each
specific program. There is no documentation on file with any discussion or request to make changes to

4

classrooms.

1
2

5

Per the PRE-LICENSING VISIT of 02/05/2007
6
The PRESCHOOL PROGRAM (classrooms #2,3,4,6,8,9,10), are the designated rooms to be utilized
7
for the PRESCHOOL PROGRAM. Per the fire clearance of 08/10/2007, these are the rooms designated for
8
the PRESCHOOL PROGRAM. Fire Clearance does not address Room 10, and is designated as the Arts &
9
Crafts Room. The Arts & Crafts Room is being utilized as the Staff lounge now.
10
The INFANT PROGRAM (classroom #1)-designated for the INFANT PROGRAM. Facility sketch on
11
file reflects that there is a designated sleeping INFANT AREA. Room has changed.
12
13 The SCHOOL-AGE PROGRAM (classrooms #5 and 7) -designated for the SCHOOL-AGE
.
14 PROGRAM.
15 Changes have been made to two PROGRAMS, and there is no documentation on file to reflect that
16 the changes have been made. No fire clearance for each specific program has been submitted.
17 Any changes made to each specific program with regards to classrooms need to be submitted to
18 the licensing office in writing for approval PRIOR to the changes being made. The changes may
19 affect capacity for each program, and a new fire clearance needs to be ordered, with each specific
20
request for each program.
21
Per
Title 22, SEE LIC 8090 for deficiencies. APPEAL RIGHTS LEFT AT FACILITY.
22
This
report shall be made available for review for the next three years.
23
24 For changes in program-Submit an LIC 200, Current updated facility sketch, Local Fire Inspection
25 Request. Any other documents will be requested. An updated sketch to be submitted within 5 days.
SUPERVISOR'S NAME: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2013

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

Uo..MA>~

DATE: 03/13/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
UC809 (FAS)· (06/04)

Page: 1 of 2

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCl.D Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

. FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I

FACILITY NUMBER: 364818120
VISIT DATE: 03/13/2013
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

Type B
03/18/2013
Section Cited
101212(e)(4)

1
2
3
4

Reporting Requirements
The items below shall be reported to the
Department within 10 working days following their
occurrence: Any changes in the plan of operation
5 that affect services to children.
6 Infant napping classroom has been changed to
7 room 10, which is designated for

1
2
3
4

Proof of correction to be submitted by due date.
Classrooms specified during prelicensig inspection
shall be utilized for each specific program, unless
requested in writing prior to changes, and approval
5 from the licensing office has been received.

6
7

8 the preschool license. No documentation on file to 8
9 reflect a written request for changes to be made for 9
10 this program. Room 9 is designated as the ARTS & 10
11
11 CRAFTS ROOM, for PRESCHOOL, and is now
12
12 being utilized as the Staff Lounge.
13
13
14
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

Fa1lure to correct the c1ted deficiency(ies), on or before the Plan of Correction (POC) due date, may result m
a civil penalty assessment.
SUPERVISOR'S NAME: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2013

FACILITY REPRESENTATIVE SIGNATURE:

£)~)

LIC809 (FAS) • (OG/04)

DATE: 03/13/2013

Page: 2 of 2

 All POC Have Been Cleared
STATE OF CALIFORNIA ·HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CLEARED DEFICIENCIES

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92!01

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 03/13/2013

POC Due Date/
Section Number

.

0311812013
101212(e)(4)

Date Cleared I
Comments

PLAN OF CORRECTIONS(POCs)

1
2 Proof of correction to be submitted by due date.

3 Classrooms specified during prelicensig inspection shall be
4 utilized for each specific program, unless requested in writing

5 rior to changes, and approval from the licensing office has
6 been received.·

1
03/1812013
2
corrected 0311812013.
3

4

7
'

8

9
10
11
12
13
14

Section Cited

1
2
3
4

5
6
7

Section Cited

1
2
3
4

5

6
7

1
2

3
4

1
2
3

4

1
2
3
4

 STATE OF CALIFORNIA . HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR:DENETRA GRANT
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
SAN BERNARDINO
CITY:
STATE:CA
CAPACITY:
40
CENSUS: 7
UNANNOUNCED
TYPE OF VISIT: Case Management- Other
MET WITH:
Rohith Senewiratne

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-11 00
92405
02/11/2013
02:55PM
04:40PM

NARRATIVE
1
2

3
4

5
6
7
8
9
10
11
12
13
14
15
16

1~

19
2o

~~

23
24
25

Licensing Program Analysts Teresa Aguiar and Kim Leung conducted a site visit
this date. Census- lnfants-2, school age-9, preschool-?
The following information is being requested. During the last annual meeting
information was requested for updating of file. On this date, the following is being
discussed with Rohith Senewiratne
1- Licensee is being advised that a new application will need to be submitted
within 30 days of this date. Letter/statement from "partners" that the partnership
will be dissolved the day the application is reviewed and licensed. Or, as d
iscussed this date, Mr. Senewiratne will meet with partners for follow up.
2- Copy of an updated PARENT HANDBOOK as previously requested. Previous
information on file reflects that no transportation is being provided and that no
meals will be provided. A CURRENT HANDBOOK is being requested for all three
programs on the premises.
3. Mr. Senewiratne states that he will update information on the partnership
agreement.
4. LIC 500 Personnel Summary Report with staff hours and duties for each
program
An exit interview conducted. This report shall be made available for review for the
next three years.

SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

.

,

-,)

·/~~-..........

DATE: 02/11/2013

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

L;IK/kV"

,d

DATE: 02/11/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC609 (FAS) • (06/04)

Page: 1 or 1

 STATE OF CALIFORNIA ·HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
FACILITY NUMBER:
ADMINISTRATOR: DENETRA GRANT
FACILITY TYPE:
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
TELEPHONE:
CITY:
SAN BERNARDINO
ZIP CODE:
STATE:CA
CAPACITY:
40
DATE:
CENSUS: 11
UNANNOUNCED TIME BEGAN:
TYPE OF VISIT: Annual/Random
MET WITH:
ANGIE BUSTILLOS
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
01/22/2013
10:50 AM
06:40PM

NARRATIVE
1
2
3
4
5
6

7
8
9

(T-2)

(T-2) Licensing Program Analyst Teresa Aguiar conducted a random annual visit. Other
licensed programs at this site were also reviewed today:
Infant Center: Census: 1- Preschool: Census: 11
School-Age DC Center- Census: 0
• A random review of 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 needs to be posted in all areas.
Menu

10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

~-----

DATE: 01/22/2013

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 {FAS) • (06!04)

Page: 1 or 6

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 01/22/2013

NARRATIVE

1

CONTINUED-PAGE 2

2

• The licensee has been informed that all employees must be associated to the facility. A civil
penalty of $1 00 per person will be assessed for failure to have fingerprints cleared or failure to
associate a previously cleared individual to the facility.
• A review of staff records on 01/22/2013 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 following civil penalty information was discussed: If a facility is cited for a serious deficiency
and then repeats the same violation within a 12 month period, an immediate penalty of $150 shall
be assessed and a penalty of $50 per day shall be assessed until the deficiency is corrected. If the
facility repeats the same violation for a third time within the same 12 month period, the facility will be
cited and assessed an immediate penalty of $150 for that day and $150 per day until the deficiency
is corrected. The facility representative was advised how to access forms and regulations for Child
Care Centers online at www.dss.cahwnet.gov or ccld.ca.gov
• The "Notification of Parent's Rights" (PUB3g3 dated [8/02]) poster was posted at the facility
representative and they were advised that it must be posted in an area of the facility accessible to
parents. The information regarding new legislation with regards to exemptions and Parent's Rights
was also discussed.
• The facility representative was notified that violations of the sections pertaining to Parent's Rights
sections 101218.1 (b)(8), (c), (d), (e), (e)(1 ), or (e)(2) are subject to three tier civil penalties.

3
4

5
6
7
8
9
10

11
12
13
14
15
16
17
18
19
20
21

22

23
24
SEE LJC 8090 for deficiencies. Appeal rights left at facility
25
26
This report shall be made available for review for the next three years.
27
28
29
30
31
32
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2013

1 acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2013

LIC809 (FAS)· (06104)

Page:2of6

 STATE OF CALIFORNIA. HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING ONIS10N

FACILITY EVALUATION REPORT (Cont)

CCLD RGglonal Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 01/22/2013

NARRATIVE

1

CONTINUED-PAGE 3

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

• AB 2084-Effective 01/01/2012, The law requires that:
• Whenever milk is served, serve only low-fat (1 %) milk or nonfat milk to children two years of age
or older.
• Limit juice to not more than one serving per day of 100% 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.
• Make clean and safe drinking water readily available and accessible to children for consumption
throughout the day.
• The facility representative was advised that the Notice of Site Visit must be posted in an area of
the facility accessible to parents for a period of 30 days. If a serious violation is cited, a copy of the
licensing report (LIC809 or LIC9099) must be posted for 30 days.
• Reviewed type A deficiency if 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.
• A review of resident and/or staff records on 01/22/2013 indicates that all facility staff or other
individuals who require caregiver background checks have received criminal record and child abuse
index clearances or exemptions.
Flooring discussed this date with Rohith Senewiratne. Flooring is being installed by maintennance
personnel.
See LIC809D for cited deficiencies in accordance with the California Code of Regulations
Title 22, Division 12.
An exit interview was conducted, appeal rights discussed and a copy of this report was provided.

A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISOR'S NAME: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

_./j.---

DATE: 01/22/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

~Q~
UC809 (FAS)· (06/04)

DATE: 01/22/2013

Page: 3 of6

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date/

FACILITY NUMBER: 364818120
VISIT DATE: 01/22/2013
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

1 HEALTH AND SAFETY CODE

Type A
01/23/2013
Section Cited

1596.8595

Type A
01/23/2013
Section Cited

101238.2(e)(1)

Type A
01/23/2013
Section Cited

101238

2 Section 1596.8595 and 1596.8695
3 Review of children's files reflects that the LtC 9224
4 "Acknowlegement of Licensing Reports have not
5 been provided to parens of children from last visit

1 Written proof to be submitted by due date.
2

3
4

6 of01/14/2013.
7

5
6
7

1
2
3
4
5
6
7

6
7

1 Proof of correction to be submitted by due date
As a condition of licensure, the areas around and
under high climbing equipment, swings, slides and 2
3
other similar equipment shall be cushioned with
4
material that absorbs falls. Aea under swings is
5
tacking cushion for safety.

1
2
3
4
5
6
7

1
2
3
4
5
6
7

1 BUILDINGS AND GROUNDS

1 Written proof to be submitted by due date.
2
3
4
5
6
7

2 he child care center shalt be clean, safe, sanitary
3 and in good repair at all times to ensure the safety
4 and well~being of children, employees and visitors.
5 Water fountain outside has sand/small dust in
6 fountain. Toys outside in need of cleaning, dirt
7 spots. This poses a hazard to children in care.

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: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

~

DATE: 01/22/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2013

This Notice must be posted for 30 days
LIC809 (FAS) • (06/04)

Page: 4 of6

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 9Z501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:

FACILITY NUMBER: 364818120
VISIT DATE: 01/22/2013

Deficiency Type

POC Due Date I

PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

Type A
01/23/2013
Section Cited

101238(a)

Type A
01/23/2013
Section Cited

101238(g)

Section Cited

1

1
2
3
4
5
6

BUILDINGS AND GROUNDS

he child care center shall be clean, safe, sanitary
and in good repair at all times to ensure the safety
and well-being of children, employees and visitors.
Toys outside in need of cleaning. Toys have dirt all
over, and need cleaning. Poses a safety hazard to
7 children in care.

1
2
3
4
5

BUILIDNGS AND GROUNDS

Disinfectants, cleaning solutions, poisons and othe
items that could pose a danger if readily available
to children shall be stored where inaccessible to
children. A can of Raid noted in bathroom in
6 preschool section on 01/14/2013 during visit in
7 bathroom and on this date.

1 Written proof of correction to be submitted by due
2 date.
3
4
5
6

7
1 Removed during the visit.
2
3
4
5
6

7

8 Raid can on top of a cabinet.
9
10
11
12
13
14

8
9
10
11
12
13
14

1
2
3
4
5
6

1
2
3
4
5
6

7

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: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

c#

DATE: 01/22/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2013

This Notice must be posted for 30 days
LIC609 (FAS) • (06104)

Page: 5 of6

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700

COMMUNITY CARE LICENSING DIVISION

RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:

FACILITY NUMBER: 364818120
VISIT DATE: 01/22/2013

Deficiency Type

POC Oue Date I

PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

1 BUILDINGS AND GROUNDS

Type 8
01/23/2013
Section Cited
101238(a)

Type B
01/25/2013
Section Cited
101216(g)

2
3
4
5
6

The child care center shall be clean, safe, sanitary
and in good repair at all times to ensure the safety
and well-being of children, employees and visitors.
Swing set is noted to have a nonworking swing
hanging on top of swing area, nonfunctioning.
7 Poses a hazard.

1
2
3
4
5
6

PERSONNEL REQUIREMENTS

At least one staff member who is trained in
pediatric cardiopulmonary resuscitation and
pediatric first aid pursuant to Health and Safety
Code Section 1596.866 shall be present when
children are at the child care center or off site for
7 center activities.

8 File review notes that there are no staff who have
9 First Aid/Cpr on file.
10
11
12
13
14

Type 8
01/31/2013
Section Cited
101216(g)(2)

Each person specified in (g) above shall Personnel
Requirements
have a health~screening report signed by the
person performing the screening. This report shall
indicate the following: The person's physical
qualifications to perform the duties to be assigned.
Rebeka Chowdhury, Monica Lograno, and April
7 Lograno lack health scrreenings on file.

1
2
3
4
5
6

1 Written proof of correction to be submitted by due
2 date.
3
4
5
6

7
1 Proof of correction to be submtited by due date.
2

3
4
5
6

7
8

9
10
11
12
13
14
Proof of correction to be submitted by due date.

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: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar

..--

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2013

LIC809 (FAS) • (06/04)

Page: 6 of6

 All POC Have Been Cleared
STATE OF CAUFORNIA ·HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CLEARED DEFICIENCIES

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 0112212013

POC Due Date I
Section Number

0112312013
1596.8595

1
2
3
4

~ritten proof to be submitted by due date.

5
6
7
01/23/2013
Section Cited
101238.2(e)(1)

1
2
3
4 Proof of correction to be submitted by due date

5
6
7

Section Cited

1
2
3

4
5

6
7
01/23/2013

1

Section Cited

2

101238

Date Cleared I
Comments

PLAN OF CORRECTIONS(POCs)

3
4 Written proof to be submitted by due date.

5
6
7

1
2
3
4

01123/2013
Forms signed by parents.

01/23/2013
1
2 Woodchips ordered and delivered this
3 week.

4

1
2
3
4

01/23/2013
1
2 Wirtten documentation submitted.
3 Fountain and toys cleaned.

4

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

02/04/2013
LITTLE MOUNTAIN PRESCHOOL
364818120
2419 HEAVENLY WAY
CORONA, CA 92881
Letter of Deficiency Citations Cleared
Dear Licensee,

The following deficiencies, initially cited during a visit on 01/22/2013, have been cleared:
Section Cited: 1596.8595
Plan of Correction:

Date Due: 01/23/2013
Corrections:

Written proof to be submitted by due date.

Forms signed by parents.

Clearance Date:
01/23/2013

Section Cited: 101238.2(e)(1)
Plan of Correction:

Date Due: 01/23/2013
Corrections:

Clearance Date:

Proof of correction to be submitted by due date

Woodchips ordered and delivered this
week.

Section Cited: 101238
Plan of Correction:

Date Due: 01123/2013
Corrections:

Written proof to be submitted by due date.

Wirtten documentation submitted.
Fountain and toys cleaned.

LICENSING EVALUATOR NAME: Teresa Aguiar

01/23/2013

Clearance Date:
01/23/2013

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

_,I , : . - - - -

DATE: 02/04/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS) • (04105)

Page: 1 of 1

 All POC Have Been Cleared
STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CLEARED DEFICIENCIES

CCLO Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 01/22/2013

POC Due Date I

Date Cleared I
Comments

PLAN OF CORRECTIONS(POCs)

Section Number

0112312013
10123B(a)

1
2
3
4 ~rltten proof of correction to be submitted by due date.

5
6
7
0112312013
Section Cited
101238(g)

1
2
3
4 Removed during the visit.

5
6
7
8
9
10
11
12
13
14

Section Cited
1

1
2
3
4

5
6
7

1
0112312013
2 Written documentation that toys were
3 washed.

4

0112212013
1
2 Raid removed and made inaccessible

3 during the visit.
4

1
2
3
4

1
2
3
4

 STATE OF CALIFORNIA. HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

02/04/2013
LITTLE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881
Letter of Deficiency Citations Cleared

Dear Licensee,
The following deficiencies, initially cited during a visit on 01/22/2013, have been cleared:
Section Cited: 10123B(a)
Plan of Correction:
Written proof of correction to be submitted by due date.

Section Cited: 10123B(g)
Plan of Correction:
Removed during the visit.

Date Due: 01/23/2013
Corrections:
Written documentation that toys were
washed.

Clearance Date:

Date Due: 01/23/2013
Corrections:
Raid removed and made inaccessible

Clearance Date:

01/23/2013

01/22/2013

during the visit.

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

~

DATE: 02/04/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS}. (04105}

Page: 1 of 1

 . All POC Have Been Cleared
STATE OF CALIFORNIA" HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CLEARED DEFICIENCIES

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

VISIT DATE: 0112212013
POC Due Date I
Section Number

01/23/2013
101238(a)

Date Cleared I
Comments

PLAN OF CORRECTIONS(POCs)

1
2
3
4 Written proof of correction to be submitted by due date.
5
6

1
01/23/2013
2 Written documentation that swing was
3 removed.

4

7
01/25/2013
Section Cited
101216(g)

1
2
3
4 Proof of correction to be submtited by due date.
5
6

01/25/2013
1 Per documentation, staff Deri1etra Grant,
2 Monica Lograno and Angie Bustillo have
~ current CPR/First Aid on file

7
8
9
10
11
12
13
14
01/31/2013
Section Cited
101216(g)(2)

1
2

3
4 Proof of correction to be submitted by due date.

5
6

7

1
2
3
4

01/23/2013
1 Written documentation submitted that all
2 staff will have completed health
~ screening by 02/01/2013.

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

02/04/2013
LITTLE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 01/22/2013, have been cleared:
Section Cited: 101238(a)

Date Due: 01/23/2013

Plan of Correction:
Written proof of correction to be submitted by due date.

Corrections:
Written documentation that swing was
removed.

Section Cited: 101216(g)

Date Due: 01/25/2013

Plan of Correction:

Corrections:
Per documentation, staff Demetra

Proof of correction to be submtited by due date.

Clearance Date:
01/23/2013

Clearance Date:
01/25/2013

Grant, Monica Lograno and Angie
Bustillo have current CPR/First Aid on
file
Section Cited: 101216(g)(2)

Date Due: 01/31/2013

Plan of Correction:

Corrections:
Written documentation submitted that
an staff will have completed health

Proof of correction to be submitted by due date.

Clearance Date:
01/23/2013

screening by 02/01/2013.

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS). (04105}

Page: 1 of 1

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
FACILITY NUMBER:
ADMINISTRATOR:DENETRA GRANT
FACILITY TYPE:
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
TELEPHONE:
SAN BERNARDINO
CITY:
STATE:CA
ZIP CODE:
CAPACITY:
40
DATE:
CENSUS: 18
UNANNOUNCED TIME BEGAN:
TYPE OF VISIT:
Case Management- Other
MET WITH:
ANGIE BUSTILLAS
TIME COMPLETED:

1
2
3
4

364818120
850
9098821100
92405
01/14/2013
01:30PM
05:30PM

NARRATIVE
Licensing Program Analyst (LPA) Teresa Aguiar conducted a case management site visit this date. During the
visit, LPA Aguiar conducted a walk through of the premises.
Census and ratios taken this date. Two classrooms are in disarray, and are not being utilized at this time. The
sketch reflects that these rooms are classroom #3 and #4 are for preschool.

5
6
During the walk through, LPA observed the following and will be cited accordingly.
7
1-The census in room #2 upon arrival is 20 children with a volunteer. Angie Bustillos assisted with visit. LPA
8
Aguiar advised Ms. Bustillos that the last fire clearance of 02/06/2008 reflects that room #2 is only to have 17
9
children at one time. There. were 20 upon arrival.
10
11
2-The urinal in the boys bathroom is covered and not able to be used at this time due to non-function.
12
Bathroom in room 3 is non-functioning when flushed and is full of brown matter
13
14 3-Room #3 and #4 are being utilized and kept as storage rooms. Both rooms have flooring that needs to be
15 repaired. Flooring in preschool area needs areas of repair.
16 SEE LIC 809D FOR DEFICIENCIES
17
18 Being requested this date-to be submitted within 24 hours
19 1-LIC 500-Personnel Record with staff hours and duties for all programs to include drivers
20 2-AII staff drivers license for those staff who transport children to and/or from school.
21
3-An updated facility sketch to reflect rooms being utilized for various classes22
Due to time constraints, more time will be needed to return to the facility for further follow up.
23 A copy of this report shall be made available to the public for the next three years.
24
25
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2013

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

~ (6~ri

DATE: 01/14/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
UC809 (FAS) • (06104)

Page: 1 of 4

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNin' CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I

FACILITY NUMBER: 364818120
VISIT DATE: 01/14/2013
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

Type A
01/15/2013
Section Cited

101179(a)(3)

Type A
01/15/2013
Section Cited

101238.3(b)

1
2
3
4
5
6
7

CAPACITY DETERMINATION
The license shall be issued for a specific capacity,
which shall be the maximum number of children
that can be cared for at any given time. The
Department may issue a license for fewer children
than requested. Physical features of the child care
center, including available space,

8
9
10
11
12
13
14

02/06/2008. This shall cease immediately. 17

1
2
3
4
5
6
7

The floors of all rooms shall have a surface that is
safe and clean. The flooring in various areas is in
need of repair/replacement. The areas are
embedded in deep areas-free of flooring that pose
a safety hazard to chidlren in care.

that are necessary to comply with this chapter.
Room #2 has 20 children upn arrival, and room is
only fire cleared for 17 per last fire clearance of
children shall be allowed in census/capacity for
room #2.

INDOOR ACTIVITY SPACE

8
9
10
11
12
13
14

1 This shall take effect immediately-01/14/2013.
2
3
4
5
6
7
8
9
10
11
12
13
14
1 Proof/Plan as to how this will be corrected.
2
3
4
5
6
7
8
9
10
11
12
13
14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC} due date, may result m
a civil penalty assessment.
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

~

DATE: 01/14/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2013

This Notice must be posted for 30 days
LICB09 {FAS) • {06/04)

Page: 2 of 4

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I
Section Number

Type A
01/15/2013
Section Cited
101239(e)(4)

Type A
01/15/2013
Section Cited
10123B(a)

FACILITY NUMBER: 364818120
VISIT DATE: 01/14/2013
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES
1
2
3
4

FIXUTRES, FURNITURE, EQUIPMENT AND
SUPPLIES

All toilets, handwashing and bathing facilities shall
be maintained in safe and sanitary operating
5 condition. Additional equipment, aids and/or
6 conveniences shall be provided as needed in
7 centers that serve children with

1 Proof of correction to be submitted by due date.
2
3
4

5
6
7

8 physical disabilities.

8

9
10
11
12
13
14

9
10
11
12
13
14

1-The urinal in the boys bathroom is covered and
not able to be used at this time due to non-function.
2-Bathroom in room 3 is non-functioning when
flushed and is full of brown matter.

1 BUILDINGS AND GROUNDS
2 The child care center shall be clean, safe, sanitary
3 and in good repair at all times to ensure the safety
4 and well-being of children, employees and visitors.
5 Areas in room 3 and 4 are in need of cleaning, and
6 have various objects thrown in the rooms. Areas
7 used for storage.

6
7

8 Area needs items removed that are stored, and

8

9 cleared out for use as a classroom.
10
11
12
13
14

9
10
11
12
13
14

1 Proof of correction to be submitted by due date.
2

3
4
5

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: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2013

This Notice must be posted for 30 days
LIC809 (FAS)· (OG/04)

Page: 3 of 4

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

STATE OF CAUFORNIA ·HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE. CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I

FACILITY NUMBER: 364818120
VISIT DATE: 01/14/2013
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

Type A
01/15/2013
Section Cited

101161(a)

1
2
3
4
5
6
7

1 This shall cease immediately. Written proof as to
LIMITATIONS ON CAPACITY AND
AMBULATORY STATUS licensee shall not operate 2 how this will be corrected shall be submitted in
3 writing by due date.
a child care center beyond the conditions and
4
limitations specified on the license, including the
5
capacity limitation.
6
Upon arrival, two school age children were
7
observed in the preschool room while children

8 were napping. Teacher who was assigned was

8

9
10
11
12

9
10
11
12
13
14

13
14

transporting. Two children were being monitored by
teacher/volunteer in preschool classroom. Two
children were not asigned to this class-they were
from the school age program.

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 m
a civil penalty assessment.
SUPERVISOR'S NAME: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

~

DATE: 01/14/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

r-3~

DATE: 01/14/2013

This Notice must be posted for 30 days
LIC809 (FAS) • (06/04)

Page: 4 of4

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

02/04/2013
UTILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 01/14/2013, have been cleared:
Section Cited: 101239(e)(4)

Date Due: 01/15/2013

Plan of Correction:

Corrections:
Urninal functioning
Bathroom functioning

Proof of correction to be submitted by due date.

Clearance Date:
01/15/2013

Section Cited: 101238(a)

Date Due: 01/15/2013

Plan of Correction:

Corrections:

Proof of correction to be submitted by due date.

Rooms cleaned.
01/15/2013
Per written documentation -floors to be
repaired by carpet layer

LICENSING EVALUATOR NAME: Teresa Aguiar

Clearance Date:

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS) - (04/05)

Page: 1 of 1

 All POC Have Been Cleared
STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CLEARED DEFICIENCIES

CCLD Regional OffiCe, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 01/14/2013

POC Due Date I
Section Number

01/15/2013
101239(e)(4)

Comments
1
2
3
4 Proof of correction to be submitted by due date.

5
6
7
8
9
10
11
12
13
14
01/15/2013
Section Cited

101238(a)

Date Cleared I

PLAN OF CORRECTIONS(POCs)

1
2
3
4 Proof of correction to be submitted by due date.

5
6
7

8
9
10
11
12
13
14

1

01/15/2013

2 Urninal functioning
3 Bathroom functioning

4

1
2
3
4

01/15/2013
1 Rooms cleaned.
2 Per written documentation
3 repaired by carpet layer
4

1
2
3
4

~floors

to be

 STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

02/04/2013
LITTLE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 01/14/2013, have been cleared:
Section Cited: 101179(a)(3)
Plan of Correction:
This shall take effect immediateJy.01/14/2013.

Section Cited: 101238.3(b)
Plan of Correction:
Proof/Plan as to how this wHJ be corrected.

LICENSING EVALUATOR NAME: Teresa Aguiar

Date Due: 0111512013
Corrections:
Clearance Date:
Written documentation that children will 01/15/2013
be moved to room that allows for
capacity on site in room.
Date Due: 01/15/2013
Corrections:
Classroom 3 and 4 have been cleared
and arranged as functiioning
classrooms.

Clearance Date:
01/15/2013

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 02104/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS). (04/05)

Page: 1 of 1

 All POC Have Been Cleared
STATE OF CALIFORNIA. HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CLEARED DEFICIENCIES

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120

FACILITY NAME: LITILE MOUNTAIN PRESCHOOL

VISIT DATE: 01/14/2013
POC Due Date I
Section Number

01/15/2013
101179(a)(3)

1
2
3
4 his shall take effect immediately-01/14/2013.
5
6
7
8
9
10
11
12
13
14

01/15/2013
Section Cited
101238.3(b)

Date Cleared I
Comments

PLAN OF CORRECTIONS(POCs)

1
2

3
4 Proof/Plan as to how this will be corrected.

5
6
7

8
9
10
11
12
13
14

1

01/15/2013

Written documentation that children will
2
be moved to room that allows for
3
capacity on site in room.

4

1
2
3
4

1

01/15/2013

2 Classroom 3 and 4 have been cleared
3 and arranged as functiioning classrooms.

4

1
2
3
4

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALlFORWA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

0210412013
UTILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 01/1412013, have been cleared:
Section Cited: 101161(a)

Date Due: 0111512013

Plan of Correction:

Corrections:
Clearance Date:
Per Rohith Senewiratne, bus schedule 01/15/2013
to be assigned to teachers for bus runs
and adequate staff availability.

This shall cease immediately. Written proof as to how this will be
corrected shall be submitted in writing by due date.

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

._/

DATE: 02/0412013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Leiter (FAS). (04105)

Page: 1 of 1

 All POC Have Been Cleared
STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CLEARED DEFICIENCIES

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 01/14/2013

POC Due Date I

Date Cleared I
Comments

PLAN OF CORRECTIONS(POCs)

Section Number

01/15/2013
101161(a)

1
2
3

4 his shall cease immediately. Written proof as to how this will
be corrected shall be submitted in writing by due date.
5

6
7

1

8
9

10
11
12
13
14

Section Cited

Section Cited

1
2
3
4
5
6
7
1
2
3
4
5
6
7

01/15/2013

Per Rohith Senewiratne, bus schedule to
2
be assigned to teachers for bus runs and
3
adequate staff availability.
4

1
2

3
4

1
2
3
4

1
2
3
4

 All POC Have Been Cleared
STATE OF CALIFORNIA ·HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CLEARED DEFICIENCIES

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

VISIT DATE: 01/14/2013
POC Due Date I
Section Number

01/15/2013
101216.2 (d)

Date Cleared I
Comments

PLAN OF CORRECTIONS(POCs)

1
2

!

Licensee shall submit a written plan to reflect how volunteers
5 ~ill not be left alone with children in care.
6

1
01/14/2013
2 Discussed with Director-Volunteers shall
3 never be left alone with children.
4

7
8
9
10
11
12
13
14
01/15/2013
Section Cited
101238.2(c)

1
2
3
4 Proof of correction to be submitted by due date.
5
6

1
2

3
4

1

~
4

7
8
9
10
11
12
13
14

1
2

3
4

01/15/2013
Written proof that fence was made safe.

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

02104/2013
UTILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 0111412013, have been cleared:
Section Cited: 101216.2 (d)

Date Due: 0111512013

Plan of Correction:
Licensee shall submit a written plan to reflect how volunteers will not
be left alone with children in care.

Corrections:
Discussed with Director~Volunteers
shall never be left alone with children.

Section Cited: 101238.2(c)

Date Due: 01/15/2013

Plan of Correction:

Corrections:
Written proof that fence was made
safe.

Proof of correction to be submitted by due date.

LICENSING EVALUATOR NAME: Teresa Aguiar

Clearance Date:
01/14/2013

Clearance Date:
01/15/2013

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS)- (04105)

Page: 1 of 1

 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
ADMINISTRATOR:AUCIA KASSENS
ADDRESS:
2915 N. UTILE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:CA
CAPACITY:
40
CENSUS: 10
UNANNOUNCED
TYPE OF VISIT: Case Management
Pam Morrisey
MET WITH:

1
2
3
4
5
6

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92406
04/26/2010
10:15 AM
11:10AM

NARRATIVE
Licensing Program Analyst (LPA) James Wilkerson arrived at the facility to conduct a visit regarding a
self-reported Unusual Incident Report (UIR) that occurred on April9, 2010. LPA met with Director, Pam
Morrisey and conducted census. LPA observed the subject child that was involved in the incident in his/her
classroom with a bandage on the forehead. The child had allegedly been running and tripped and hit his/her
forehead on a table. A staff member who witnessed this incident as it unfolded is not present in the facility
during this visit to interview. LPA will return on a later date to conclude this visit.

7
8

An exit interview was conducted and a copy of this report was provided to Director, Pam Morrisey on this date.

9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951 )782-4200

LICENSING EVALUATOR NAME: James Wilkerson

TELEPHONE: (951) 218-7031

LICENSING EVALUATOR SIGNATURE:

J{)hnMJ tJ~~

DATE: 04/26/2010

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

DATE: 04/26/2010

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS)- {OG/04)

Page: 1 or 1

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE L\CE:NSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR: ALICIA KASSENS
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:CA
CAPACITY:
40
CENSUS: 22
UNANNOUNCED
TYPE OF VISIT: Case Management
MET WITH:
Director/Pam Morrisey

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
05/25/2010
12:55 PM
01:45PM

NARRATIVE
Licensing Program Analyst (LPA) arrived at the facility on a case management visit to follow-up on
an unusual incident report submitted by the facility on 04/09/10. At the time of visit, LPA toured the
facility (specifically where the reported incident took place), took census, and met with DirectorPam Morrisey to discuss the reported incident. During the visit, LPA also spoke with the Teacher(s)
who witnessed the incident as it took place. The subject child(ren) involved in the incident was/were
interviewed by the LPA as well.
Based on the information obtained during the visit, as well as an inspection of the table
(photographs of file), there appeared to be no violations of Title 22 Regulations pertaining to the
reported incident.
An exit interview was held with Director- Pam Morrisey. A Notice of Site visit was issued, along with
a copy of this report. This report shall be public record for three years.

22
23
24
25
SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951 )782-4200

LICENSING EVALUATOR NAME: James Wilkerson

TELEPHONE: (951) 218-7031

LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2010

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/201 0

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) • (06104}

Page:1of1

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

07/13/2011
LITTLE MOUNTAIN PRESCHOOL
364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 07/07/2011, have been cleared:
Section Cited: 101161(a)

Date Due: 07/08/2011

Plan of Correction:

Corrections:

Clearance Date:

The Licensee must conduct an in·service training with all staff
members to ensure they understand the seriousness of this citation.
A copy of the agenda and sign in sheet must be submitted to the
Department by 7/08/11.

Received faxed copy on 7/8/11

07/13/2011

LICENSING EVALUATOR NAME: Joanne Domingo

TELEPHONE: (951) 233-9356

LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2011

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cl~ared POC Letter (FAS) • (04/05)

Page: 1 of 1

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY

INLAND EMPIRE CHILD
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

01/12/2010
LITTLE MOUNTAIN PRESCHOOL
364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 12/29/2009, have been cleared:
Section Cited: 101238.2 e 1
Plan of Correction:

Date Due: 01/12/2010
Corrections:

Licensee wiU order and place additional sand under and around the
slide and swing on the preschool playground. The licensee will send
a copy of the receipt of payment and a photo of the sand in place no
later than 1/12/10

Documents received

LICENSING EVALUATOR NAME: Anita Hise

Clearance Date:
01/11/2010

TELEPHONE: (951) 218-7031

LICENSING EVALUATOR SIGNATURE:
DATE: 01/1212010

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cloarcd POC Letter {FAS) ·{04105)

P;~ge:

1 of 1

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT(Cont)

CCLO Regional Office, 3737 MAIN ST., SUilE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I

FACILITY NUMBER: 364818120
VISIT DATE: 07/07/2011

DEFICIENCIES

PLAN OF CORRECTIONS(POCs)

Section Number

Type A
07/08/2011
Section Cited

101161(a)

1
2
3
4
5
6
7

Limitations on Capacity and Ambulatory Status:
The licensee shall not exceed the conditions,
limitations and capacity specified in the license.
LPAs observed 8 children present inside the school
age room, however 3 of which were preschool
children under the age of 6 years old.

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

1
2
3
4
5
6
7

1
2
3
4
5
6
7

1
2
3
4
5
6
7

The Licensee must conduct an in-service training
with all staff members to ensure they understand
the seriousness of this citation. A copy of the
agenda and sign In sheet must be submitted to the

Department by 7/08/11.

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: Anita Hise

TELEPHONE: (951) 680-6735

LICENSING EVALUATOR NAME: Aaron Ross

TELEPHONE: (951 )-233-7183

LICENSING EVALUATOR SIGNATURE:

OMVDLr<~

DATE: 07/07/2011

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE__:,<--_.,..,-

ffw/jJ

DATE: 07/07/2011

This Notice must be posted for 30 days
UC809 (FAS) • (06/04)

Page: 2 of 2

 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR:DENETRA GRANT
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE:CA
40
CAPACITY:
CENSUS: 13
UNANNOUNCED
TYPE OF VISIT: Case Management
Denetra Grant
MET WITH:

1

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92405
07/07/2011
10:15 AM
03:15PM

NARRATIVE
LPAs Aaron Ross and Joanne Domingo observed the following deficiency while at the facility:

2
3
4
5

1) LPAs observed 8 children present inside the school age room, however 3 of which were preschool children
under the age of 6 years old. LPA informed Center Director, Denetra Grant that the age requirement that was
requested by the Licensee for the school age license is from 6 years old to 12 years old.

6
7
8
9
10

Please See 809D for cited deficiencies.

11
12
13
14
15
16
17
18

19
20
21

22
23
24
25
SUPERVISOR'S NAME: Anita Hise

TELEPHONE: (951) 680-6735

LICENSING EVALUATOR NAME: Aaron Ross

TELEPHONE: (951 )-233-7183

LICENSING EVALUATOR SIGNATURE:

~Cr<~

DATE: 07/07/2011

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

M~~

DATE: 07/07/2011

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LICS09 (FAS) -(06/04)

Page: 1 of 2

 Control Number 09-CC-20130110114445
STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700

RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120
VISIT DATE: 01/14/2013

FACILITY NAME: LITILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type

POC Due Date I
Section Number

Type A
01/15/2013
Section Cited
101216.2 (d)

DEFICIENCIES
1
2
3
4
5
6
7

PERSONNEL REQUIREMENTS
The licensee may utilize volunteers provided that
such volunteers are supervised and are not
included in the center's staffing plan. It is reported
that staff member Gerry Hebbard is a volunteer.
LPA observed this employee supervising 18
children durnig the licensnig visit.

8
9
10
11
12
13
14

Type A
01/15/2013
Section Cited

101238.2(c)

1
2
3
4
5
6
7
8
9
10
11
12
13
14

PLAN OF CORRECTIONS(POCs)
1 Licensee shall submit a written plan to reflect how
2 volunteers will not be left alone with children in
3 care.
4
5
6
7
8
9
10
11
12
13
14

Outdoor Activity Space
Proof of correction to be submitted by due date.
Equipment and activity areas shall be arranged so 1
2
that there is no hazard from conflicting activities.
The play yard fence is partially made of wood. The 3
wood is splintered. LPA Aguiar conducted a walk 4

through of the play yard towards the back of the
facility. LPA Aguiar observed that the wood
against the fence on the side of the facility is
splintered through out with

5
6
7

8
protruding places of wood that is attached to
the chain link fence outside. The wood is protruding 9
10
in all areas. This is a safety hazard to children in
care. Based on observation this date, the allegation 11
12
that wood is a potential hazard is
13
14

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: Marianne Donley
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

~·

DATE: 01/14/2013

I acknowledge receipt of this fo<m and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

awe;,.

~~

DATE: 01/14/2013

This Notice must be posted for 30 days
Page: 3 of 3

 Control Number 09-CC-20130110114445
STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT (Cont)

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 01/14/2013

NARRATIVE
1

CONTINUED-PAGE 2

2
3
4
5
6
7

2-POTENTIAL HAZARDS-The play yard fence is partially made of wood. The wood is splintered.
LPA Aguiar conducted a walk through of the play yard towards the back of the facility. LPA Aguiar observed
that the wood against the fence on the side of the facility is splintered through out the wood that is placed on
the chain link fence. The wood is protruding in all areas. This is a safety hazard to children in care.
Based on observation this date, the allegation that wood is a potential hazard is SUBSTANTIATED.

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
SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2013

L1C9099 (FAS) • (06104)

Page: 2 of3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visiUinvestigation of a complaint received in our office on
01/10/2013 and conducted by Evaluator Teresa Aguiar
COMPLAINT CONTROL NUMBER: 09-CC-20130110114445
PUBLIC

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
ADMINISTRATOR:DENETRA GRANT
ADDRESS:
2915 N. UTILE MOUNTAIN DRIVE
SAN BERNARDINO
STATE:
CITY:
CAPACITY:
40
CENSUS: 18

UNANNOUNCED
MET WITH:

ROHITH SENEWIRATNE/ANGIE BUSTILLOS

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME VISIT BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-11 00
92405
01/14/2013
01:30PM
05:30PM

ALLEGATION(S):
1 UNQUALIFIED STAFF
2
3 POTENTIAL HAZARDS
4
5

6
7

8
9
INVESTIGATION FINDINGS:
1 Licensing Program Analyst (LPA) Teresa Aguiar conducted a site visit this date. Upon arrival, LPA tried to enter
2 the premises and rang the bell. No one came to the door. LPA Aguiar called the facility, and employee Gerry
3 Hebbard, allowed entry into the facility. Angie Bustillos assisted with the visit.
4 Mr. Senewiratne later arrived, LPA Aguiar conducted a walk through of the premises and census taken for the
5 three programs.
6 1-ALLEGATION-UNQUALIFIED STAFF- being left alone with the children. During the visit, LPA noted that
7 Director, Angie Bustillas left employee, Gerry Hebbard alone with the children as she came to speak to LPA.
8 Ms. Hebbard states that she does not have current CEU's in child development at this time.
9 Allegation that unqualified staff was left alone with the children in classroom was observed by this LPA upon
10 entering the premises. Ms. Hebbard denied that she is left alone with the children. Per Mr. Senewiratne and
11 Angie Bustillas, Ms. Hebbard is a volunteer and has no ECEU's in child development.
12 Based on observation, the allegation that unqualified staff, Gerry Hebbard is left alone with the children is
13 SUBSTANTIATED.
SEE LIC 9099C AND LIC 9099D
Estimated Days of Completion:
Substantiated
TELEPHONE: (951) 782-4200
SUPERVISOR'S NAME: Marianne Donley
LICENSING EVALUATOR NAME: Teresa Aguiar

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR SIGNATURE:

~

DATE: 01/14/2013

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

~~G

DATE: 01/14/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.
UC9099 (FAS)· (06/04)

Page: 1 of 3

 STATE OF CALIFORNIA. HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CONTACT SHEET

CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This form is intended to document contacts concerning the facility identified below. Such contacts may include
notification of corrections by the facility. Limit the information to public information. File on the top right side of the
facility folder. Enter t/c (telephone call) or o/v (other visit) in the first column. Enter the contact date in the second
column. Under Summary of Contacts enter relevant information including action taken and follow up. Enter initial and
last name after each entry.
FACILITY NAME

FACILITY NUMBER

UTILE MOUNTAIN PRESCHOOL

364818121

Contact Type

Date

Summary of Contacts

tic

09/17/2012

1 1@.11 :1 Oa LPA DAWN PARKER while acting as the Duty Officer spoke with the Center
2 Director, Amber who stated that the owner is out of the country at this time and his wife
3 ~id not realize that the fees had not been paid. She is either going online and
1 ~aying (which is what LPA suggested) or putting a check in the mail. LPA provided the
2 PIN number for both licenses to pay online.
dsp

3

1
2
3
1

2
3
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3

1
2
3
LIC185 (FAS) • (5/99). (PUBLIC)

Page: 1 of 1

 STATE Of CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

NOTICE OF CIVIL PENALTIES DUE
0

Qj Initial Invoice

INVOICE NO. 0902299

Final Notice

DISTRICT OR COUNTY OFFICE NUMBER 09H302/Hise

FACILITY NAME

Little Mountain Preschool
FACILITY ADDRESS

2915 N. Little Mountain Drive
CITY

STATE

San Bernardino

ZIP CODE

CA

92406

I

FACILITY NUMBER

364818120

LICENSEE{S) OR UNLICENSED FACILITY OPERATOR

ROHITH A. SENEWIRATNE
ADDRESS

SUPERVISOR APPROVAL

-.::J:;.

2419 Heavenly Way
CITY

ZIP CODE

STATE

Corona

CA

92881

r

RJL Jli CCJJ L&"'Y

I

DATE

1

06/03109

TITLE

Licensing Program Supervisor

The California Health and Safety Code, Sections 1548, 1568.0822, 1569.49, 1596.99, and 1597.62 provides for the imposition
of civil penalties against any facility which fails to take corrective action within prescribed time periods.
The California Health and Safety Code, Sections 1547, 1568.0821, 1569.485, 1596.89, 1596.891 and 1597.61 provides for
the imposition of civil penalties against any unlicensed facility which fails to take corrective action within prescribed time
periods.
The California Health and Safety Code, Sections 1522, 1568.09, 1569.17, 1596.871, and 1596.8712 provides for the
imposition of immediate civil penalties against any facility which fails to comply with fingerprinting or other criminal background
requirements.
Your facility has been found in violation of Community Care Licensing statutes and regulations.
_ _ _ _ _ __
Failure to correct the deficiency(ies) cited on the Licensing Report (LIC 809 or LIC 9099) dated_0_8_11_5_i_08
has resulted in the following civil penalty assessment of:
Penalty Amount Due ..................................... _ _ _ _ _ _ _ _ _ _ _ _ _ __,$'-'3"',0'-'0'-'0-'-.0'-'-0
Less Payment(s) Received ................................ -------------"$-'-'30'-'-0=-'-.00
$~.,500.00

Send the enclosed copy of this notice and your payment to the address shown below within 10 days. MAKE CHECKS
PAYABLE TO THE CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. Please write your invoice and facility number(s)
on your check.
Department of Social Services
Community Care Licensing
3737 Main Street, Suite 700
Riverside, CA 92501

FAILURE TO PAY CIVIL PENALTY MAY RESULT IN ANY OR ALL OF THE FOLLOWING:
•

SMALL CLAIMS COURT ACTION

•

LICENSE DENIAL, SUSPENSION, OR REVOCATION

•

SEIZURE OF PERSONAL INCOME TAX REFUNDS

LlC 422 (3102) {PUBLIC)

 STATE OF CAliFORNIA• HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

INLAND EMPIRE CHILD
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

03/23/2009
UTILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881

Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 02/20/2008, have been cleared:
Section Cited: 1012209(b)(2)
Plan of Correction:
The licensee shall obtain the TB test results for CHILD #4, and
submit a copy to Licensing by 02127/08.

Date Due: 0212712008
Corrections:
POC received by the Department on
02127/08 (via fax).

Clearance Date:
02127/2008

The facility will keep the original TB test results In the child's file.

Section Cited: 101221(8)(C)
Plan of Correction:
The licensee shall have the parent sign the Consent for Emergency
Medical Treatment form, and submit a copy to Licensing by
02/27/08.

Date Due: 02127/2008
Corrections:
POC received by lhe Department on
02121/08 (via fax).

Clearance Date:

0212112008

The facility will keep the original form in the child's file.

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:
/

DATE: 03/2312009

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter {FAS) • (04/05)

Page: 1 of 1

 NOTICE OF SITE VISIT
BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE
A site visit or complaint investigation was conducted at:
LITTLE MOUNTAIN PRESCHOOL

364818120 ON 12/29/2009
1. Were regulatory violations issued during this visit?

0

Yes

0 No

2. If regulatory violations were cited, would they pose an
immediate risk to the health and safety of children in care,
if not corrected (Type A)?

0 Yes

0 No

Yes

0 No

3. If regulatory violations were cited, could they become a risk
to the health, safety, or personal rights of children in care if
not corrected (Type B)? (Examples include a
record keeping violation that would impact the care of
children or a violation that would impact those services
required to meet children's needs.)

ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS
AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN
THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS.
Regardless of whether or not this child care facility is required to post a copy of today's site
visit report, you may view the report at the facility or obtain one by contacting the local Child
Care Regional Office at:

INLAND EMPIRE CHILD
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

Regional Office Contact Person:

Anita Hise

Contact Person Telephone Number:

(951) 218-7031

THIS NOTICE MUST BE POSTED FOR 30 DAYS
LIC92t3 (FAS)

~(1104)

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER:
FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
ADMINISTRATOR: AU CIA KASSENS
FACILITY TYPE:
ADDRESS:
2915 N. UTILE MOUNTAIN DRIVE
TELEPHONE:
CITY:
SAN BERNARDINO
STATE: CA
ZIP CODE:
CAPACITY:
40
CENSUS: 16
DATE:
TYPE OF VISIT: Annual/Required
UNANNOUNCED TIME BEGAN:
MERCEDES PARKER/PAM MORRISSEY
MET WITH:
TIME COMPLETED:

364818120
850
(909) 882-1100
92406
12/29/2009
01:15PM
04:30PM

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), Anita Hise & LaDonna Haney conducted a modified
comprehensive annual visit. LPA's Hise & Haney met with Mercedes Barker, toured the
facility, inside and out, records were reviewed and the following was observed:
Other licensed programs at this site were also reviewed today:
School-Age DC Center: Census: 12, Infant Center: Census: 4
A review of staff records and children's records is not being conducted as part of this evaluation.
The licensee will certify that all record requirements have been met. The licensee has been asked
to complete the Modified Comprehensive Visit Licensee Self-Assessment forms LIC 9198 and LIC
9199 and return them to licensing within 30 days.
• 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)

SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Anita Hise

TELEPHONE: (951) 218-7031

DATE: 12/29/2009

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

~~V0LJ((

DATE: 12/29/2009

This report must be available at Child Care and Group Home facilities for public review for 3 years.
L!C809 (FAS) • (06/04)

Page: 1 of 3

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

STATE OF CALIFORNIA ·HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120
VISIT DATE: 12/29/2009

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

• Child Car Seat Law
• Menu
• The licensee has been informed that all employees must be associated to the facility. A civil
penalty of $100 per person will be assessed for failure to have fingerprints cleared or failure to
associate a previously cleared individual to the facility.
• A review of staff records on 12/29/09 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 following civil penalty information was discussed: If a facility is cited for a serious deficiency
and then repeats the same violation within a 12 month period, an immediate penalty of $150
shall be assessed and a penalty of $50 per day shall be assessed until the deficiency is
corrected. If the facility repeats the same violation for a third time within the same 12 month
period, the facility will be cited and assessed an immediate penalty of $150 for that day and
$150 per day until the deficiency is corrected. The licensee was advised how to access forms
and regulations for Child Care Centers online at www.dss.cahwnet.gov or ccld.ca.gov
• The new "Notification of Parent's Rights" (PUB393) poster was provided and the licensee was
advised that it must be posted in an area of the facility accessible to parents. The information
regarding new legislation with regards to exemptions and Parent's Rights was also provided.
• The licensee was notified that violations of the sections pertaining to Parent's Rights sections
101218.1{b)(B), (c), (d), (e), (e)(1), or (e)(2) are subject to three tier civil penalties.
• A review of resident and/or staff records on 12/29/09 indicates that all facility staff or other
individuals who require caregiver background checks have received criminal record and child
abuse index clearances or exemptions.
SEE LIC809D for cited deficiencies in accordance with the California Code of Regulations
Title 22, Division 12.
An exit interview was conducted, appeal rights discussed and a copy of this report was provided.
A copy of this report must be made available to the public, at the facility site, for 3 years.

SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Anita Hise

TELEPHONE: (951) 218-7031

LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2009

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

~

LIC809 (FAS) • (06{{)4)

DATE: 12/29/2009

Page: 3 of3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I
Section Number

Type B
01112/2010
Section Cited
101238.2 e 1

FACILITY NUMBER: 364818120
VISIT DATE: 12/29/2009
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES
1
2
3
4
5
6
7

OUTDOOR ACTIVITY SPACE: LPA's observed the 1
2
3
4
5
6
7

lack of sand which is the cushioning material under
the swing and slide, there is exposed concrete
under both structures. The sand box has an
exposed rock in it.

Licensee will order and place additional sand under
and around the slide and swing on the preschool
playground. The licensee will send a copy of the
receipt of payment and a photo of the sand in place
no later than 1/12/10

1
2

1
2
3
4
5
6
7

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

1
2
3
4
5
6
7

3

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result m
a civil penalty assessment.
SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Anita Hise

TELEPHONE: (951) 218-7031

LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2009

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

~
LtC809 (FAS)· (06/04)

DATE: 12/29/2009

Page: 2 of 3

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY

INLAND EMPIRE CHILD
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

09/30/2009
LITTLE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881
Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 09/23/2009, have been cleared:
Section Cited: 101212 d 1 C
Plan of Correction:

Date Due: 09/30/2009
Corrections:

Director will submit an Unusual incident report regar:ling the previous
b1Ung incidents at the facility

documents received

LICENSING EVALUATOR NAME: Anita Hise

Clearance Date:
09/30/2009

TELEPHONE: (951) 218-7031

DATE: 09/30/2009

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS) . (04105)

Page: 1 or 1

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

INLAND EMPIRE CHILD
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

09/30/2009
UTILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881
Letter of Deficiency Citations Cleared
Dear Licensee,

The following deficiencies, initially cited during a visit on 09/23/2009, have been cleared:
Section Cited: 101223 a 2

Date Due: 09/24/2009

Plan of Correction:

Corrections:

Clearance Date:

Director will contact Kids N Care Resource and Referral office for
information on how to handle children who bite, and send copies of
!his infonnalion to CCL. A conference will be held with the parents to
agree on a compliance plan for this child and copies sent to CCL

documents received

09/28/2009

LICENSING EVALUATOR NAME: Anita Hise

TELEPHONE: (951) 218-7031

LICENSING EVALUATOR SIGNATURE:

r;:::::::;;:::
~~

DATE: 09/30/2009

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter (FAS) • (04/05)

Page: 1 of 1

 u-

Si

VIS I

II

!l~'!4.S=i1"'

"

A ~iie vbH

01

· -"-' b. ! ~

~

ii
ii

cumpiainl inve~Uyation wa~ t;UmiucteU dt.

IE

II

364818120 ON 09/23/2009

1. Were regulatory violations issued during this visit?
L.

11 regu1ato1y VIOlations were c1tea. wou1a tney pose an
immediate risk to the health and safety of children in care,
if not corrected (Tyoe A)?

Yes

. No

res

1~0

Yes

. No

II
5 !f

II
II
II
II
II
II
II
0£

3. I! regulatory violations were cited, could tl1ey become a risk
to the health, safety, or personal rights of children in care if
recordtzeepfng violation tl1at vvou!d 1mpact the cart of
children or a violation that would impact those services
:*Pfl: d:-:;>r-l t('l :":"'1~-2! rhl!:ir.t=:n'~ ;"l~~dS.)

ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS
THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS.

~

g

~

i!

ii

Regardle£s of whether or not this child care facility is required to post a copy of today's site
visit report, you may view the report at the facility or obtain one by contacting the local Child
Care Reqiona! Office f!t:

INLAND EMPIRE CHILD
;-,-:.-,-,

~

,j(,_}(

IVIr\ll~

·'

.~

~~'

:-;-:-

.-,, ,...,...,--

-:r.r-

01 ,, 0 U I I C. IVU

RIVERSIDE, CA 92501
Regional Office Contact Person:

Comact Person Telephone

!~umber:

Anita Hise

(95'1) 2'i 8-703'1

Ill

II

II
II
R ii

THIS NOTICE MUST BE POSTED FOR 30 DAYS

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE l!CENS!NG DIVISION

FACILITY EVALUATION REPORT

INLAND EMPIRE CHILO, 3737 MAIN ST., SUITE 700
RIVERSIDE. CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR ALICIA KASSENS

FACILITY
NUMBER:
FACILITY TYPE:

ADDRESS:
CITY:
CAPACITY:
TYPE OF VISIT:
MET WITH:

TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

2915 N. LITTLE MOUNTAIN DRIVE
SAN BERNARDINO
STATE:CA
40
CENSUS: 26
UNANNOUNCED
Case Management
PAM MORRISSEY

364818120
850
(909) 882-1100
92406
09/23/2009
02:55PM
04:30PM

NARRATIVE

1
2
3
4
5
6
7
8

LPA Hise arrived at the facility on a case management visit to follow-up on another issue. During
the investigation of that issue LPA Hise discovered in the two year old room there have been
numerous biting incidents. Some of the incidents occurred under the previous director and at least
ten incidents since July 2009. There has been no formal conference with the parent, the child has
not been placed on a compliance plan, the facility has not initated a plan to protect t11e other
cllildren in tile class from becoming victims. Based on this observation and t11e number of biting
incidents the facility is being cited for Personal Rights violation and Reporting Requiremnts.

g

10
11
12
13
14
15

16
17

See LIC809D for cited deficiencies.
An exit interview was conducted, appeal rights discussed and a copy of this report was provided to
the licensee on this date.
A copy of this report must be made available to the public for 3 years.

18
19
20
21
22
23

24
25
SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Anita Hrse

TELEPHONE: (951) 218-7031

LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2009

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

\J)r\rLo~A.,_;VJ/~}cA/)\/

DATE: 00/23/2000

This report must be available at Child Care and Group Home facilities for public review for 3 years.

 STAT!: OF CALJrORNIA -IlEAL Til AND I-lUMAN SERVICES AGENCY

CALIFORNIA DEPAfmr'IENT Of SOCIAL SC::RVJCES
COMMUNITY CARE LICENSING DIVISION

FAC!L!TY EVALU/.I.T!ON REPORT (Conti

INLAND EMPIRE CHILD, '3737 MAIN ST, SUITE 700

FACILITY NAME: LITILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
0Pfirk·nry

FACILITY NUMBER: 3648"18120
VISIT DATE: 09/23/2009

Typ~"

I ·1 l nr-r:?~flt,!t.l RJ,"'::HT~ r!)J!t[r.:.n hO:.It- nrol ;:.ur,rrl.:.rl

Type A
0912412009

PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

POC Due Date I
Section Number

21s;fe, -h~althfut a~d c;mfort~bie acc;m~od~ii~ns-.­

1:

Children have been bitten by a known bitter on
1 -~ ; numsrcus o:::CJ_Sic-r;:: ana tiw;: 133~0- !1<::: uo; t·::-on

i~ I

' '

11 I ['lir,:.dt>• •riiil r: (•PL?r:-t !{irf::. N ('.::,r,;, R.:.~r:"Y(,:,:. Fllfd

21 Referral office fer information on how to handle
who blte, and send copies of this information
1~ it·::children
r..:cL. p, ccnrcrcn;:;c \'/lH !Js i1G!d '.'!ith the p<ir0nts K
; '1

I ::) ! nnrPI:' nn "

fnrmnlly "rlrlrcr.rerl

i ')

l- I

I~ I

!

l~i

I~ i

1!1

1!1s

I~ i
i~ i

I~ i

l,

i

r.nm;-~linnr:p

I~ Isent to CCL

.

n!;:m fm th:., r.hilri i'mrl r:nnlf'?.

.

.

~I

I

I;

i i!

15 i

!

1

i' I

! '!

1~1

: ·: !
I" I
7

I" I
l

Fa1!ure to correct the cited deficien~y(ies} 1 on or before the Plan of Correction {POC} due date. may resu!t
ni ei (.,vt~ p~nany clS5et:o::snJem.
SUPERVISOR'S NAME: iviananne Uonley

"IE:LE:PHONE:: (Sl>l)

LICENSING EVALUATOR NAME: An1ta Hise

TELEPHONE: 1951) 218-7031

L!CENS!NG EV/\LU/\TOR S!GN/\.TURE:
DATE: 09/2312009

I acknowledge receipt of this form and understand my appeal rights as explained and received.
1-1-ICILII Y f·H::PRtSI:N t JJ, I !VI': SIGN/.\! URE:

DATE: 09/2312009
,<"'\,

;I

::__-f\.~~\

Thi0 Notice must be posted fc:r 30

d~v3

re~-42UU

 STATE or CALIFORNtA

_

HEALTH AND HUlvlAN sERVICEs AGENtt"AVFORNIA DEPARTMENT or :SOCIAL smvtcEs
'C'O(lJMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)
FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
n:.fi,~J.·.;•.-y

INLAND EMPJRE CHILD 3737 MAIN SL SUITE 700

FACILITY NUMBER: 364818120
VISIT DATE: 09/23/2009

Typ''-

POC Due Date I
Section Number

DEFICIENCIES

PLAN OF CORRECTIONS(POCs)

Type B
09/30/2009

101212d 1 (.;

Failure to correct the cited deficiency{ies}, on or before the Plan of Correction {POC} due date, may result
Ill a \_:I vii

perH~tiy a::.~::>e::-:.~llleni..

SUPERVISOR'S NAME: Mananne Uonley

TELEPHONE: (%1) /o;;-4;;uu

LICENSING EVALUATOR NAME: Anita Hise

TELEPHONE: (951) 218-7031

L!CENS!NG EV/\LU/\TOR. S!GN/\TURC:

DATE: 09/23/2009

I acknowledge receipt of this form and understand my appeal rights as explained and received.
rACIU IY REPRI=SI:'NIA liVt: SIGN!\TURE:
DATE: 09/23/2009

:\ .::!
t

~'

.
",

''

.\ ,.

 STAn: Or CALirORNJA ·I-lEALTil AND llUMAN SERVICES AGENCY

CALIFORNIA DEPAR1M~NT OF SOCIAL SERVI(;[S
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

INLAND EMPIRE CHILD 3737 MAIN ST SUJTE 700

FACILiTY NAME: Lll I U: MOUN I AIN PReSCHOOL

364818120

FACILiTY
NUMBER:

Fb,C!UTY TYPf::
ADDRESS:
CITY:

2915 N. LITTLE MOUNTAIN DRIVE
STATE: CA
SAN BFRNARniNO

TYPE OF VISiT:
MET WITH:

Ca~~

ivianagetne11t

UNANNOUNCED

PAM MORRISSEY

(909) 882-1100

TELEPHONE:
ZIP CODE·

9?40R

TIME BEGAN:
TIME COMPLETED:

02.55 PM
04:30PM

l\lAKI-'.AfiVt:

LPA Hise arrived at tile facility on a case management visit to follow-up on an unusual incident
r::;::r,n :::nhmHtcd hv th•" f,;d!i'fv nn cu·i r;mq ld thP :imP r:f .,_,;r,it i P.& tr:HrPrl th\· f,;dlit;,' tnnk rr:n.~:n:::
Ji~C ;·;<L:f -.-;:th ::Leete;· rc~ ~,i;Jrd~:;sy tv dbc;..;:;:; the r~pv:-::cd lncidcnL Duling th~ vi::;it, Lf"\'\ o!:;v
spoi<e with the Teacher wllo was in the classroom when the incident as it took place. The incident
took r!8re after nop nnd the teocher was cllonqinq 0 child The victim h0d been recent!v moved to
anomer play area wnen a cn11a wno n:1s no ntstory or ommg b!t. ! nere wPrf' on!v et9m cm1cren m
care at the time with one teacher supervising.

8

9
I \J

I

11 ' Reguiatrons pertarnrng to the reported rncrdent.

;21

"' I

;51
16.
..

~~

v.:itl! a cvpy vt tl!i3 ccpvrt. 1 his report shalt be. public record fof 1\l!'C,.:.:. yE,ars.

'
I.

7(1 I

:1·1 I

221
23

...

Lll.l::l"J~I!\10 t:VALUA I UK 1\lAIV!t:.: An!H:l HlS0

!I=Lt:I-'HUNt:.: (,;JO l) L. 10-/U,j I

FACILITY REPRESENTATIVE SIGNATURE:
J.

~

r';

,--rV~JZlA), A/\ /}(A

n 1\ Tr-.
........
' ....

nnJ'I?. nnnr;
'-'~'~"''~~,~-~

This report must be available at Child Care and Group Home facilities for pubiic review for 3 years.

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY

INLAND EMPIRE CHILD
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

06/30/2009
LITILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881
Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 06/25/2009, have been cleared:
Section Cited: 101229 a 1

Date Due: 0612612009
Corrections:

Plan of Correction:

Clearance Date:

Licensee will provide CCL with a policy on how visual supervision will
be provided to children in care and a sketch of where each teacher is
to be located while children are on the play ground will also be
provided. The licensee will send in a schedule and names of
relieving teachers.

a sketch was provided of teachers
0612612009
location on the play ground & a
schedule, names of relieving teachers.

Section Cited: 101212 d 1 C
Plan of Correction:

Date Due: 0612612009
Corrections:
Title 22 inservice & sign in sheet

Clearance Date:
0612612009

Date Due: 0612612009
Corrections:
Title 22 inservice & sign in sheet

Clearance Date:
06/2612009

Licensee will review this section of Title 22 with the staff and discuss
what type of incidents are to be reported. A sign in sheet with all staff provided
signature indicating this was discussed with them will be provided to
CCL

Section Cited: 101223 a 8
Plan of Correction:
Licensee will review this section of Tille 22 with the staff and discuss
what needs to be done when a child complains of an injury that may
not be seen A sign in sheet with aU staff signature indicating this was
discussed with them will be provided to CCL.

LICENSING EVALUATOR NAME: Anita Hise

c

provided

TELEPHONE: (951) 218-7031

LICENSING EVALUATOR SIGNATURE:

¢

$?;, ~ar-·

.....
,_

DATE: 06/30/2009

This report must be available at Child Care and Group Home facilities for public review for 3 years.

 NOTICE OF SITE VISIT
BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE
A site visit or complaint investigation was conducted at:
LITTLE MOUNTAIN PRESCHOOL
364818120 ON 06/25/2009

1. Were regulatory violations issued during this visit?
2. If regulatory violations were cited, would they pose an
immediate risk to the health and safety of children in care,
if not corrected (Type A)?
3. If regulatory violations were cited, could they become a risk
to the health, safety, or personal rights of children in care if
not corrected (Type B)? (Examples include a
recordkeeping violation that would impact the care of
children or a violation that would impact those services
required to meet children's needs.)

[]Yes

[] No

Yes

[.1 No

[] Yes

[] No

ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS
AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN
THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS.
Regardless of whether or not this child care facility is required to post a copy of today's site
visit report, you may view the report at the facility or obtain one by contacting the local Child
Care Regional Office at:

INLAND EMPIRE CHILD
3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

Regional Office Contact Person:

Anita Hise

Contact Person Telephone Number:

(951) 218-7031

THIS NOTICE MUST BE POSTED FOR 30 DAYS
L\C9'213 (FAS)- {1104)

 STATE OF CALIFORNIA -HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT

INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2009 and conducted by Evaluator Anita Hise
PUBLIC
COMPLAlNT CONTROL NUMBER: 09-CC-20090616165646
FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR ALICIA KASSENS
ADDRESS:
CITY:
CAPACITY:

MET WITH:

2915 N. LITTLE MOUNTAIN DRIVE
SAN BERNARDINO
STATE:
40
CENSUS: 34
UNANNOUNCED
ALICIA KASSEN

FACILITY
NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME VISIT
BEGAN:
TIME COMPLETED:

364818120
850
(909) 882-1100
92406
06/25/2009
01:15PM
04:45PM

ALLEGATION(S):
1 Lack of supervision: staff not aware child was injured while in care.
2 Reporting requirements: failure to report child Injury.
3 Neglect: child's injury not addressed.
4
5
6
7

8
9
INVESTIGATION FINDINGS:
1 LPA Anita Hise arrived at the facility to conduct an investigation into the above allegation(s). LPA met with
2 Director Alicia Kassen toured the facility, and interviewed additional staff. Based on statements, documents
3 obtained, information obtained during interviews conducted, the child in question had been in care of this
4 facility for approximately three weeks. The child was to sustain a chipped tooth at the facility on 6/09/09, the
5 chipped tooth was discovered by the parent after pick up from the facility. When the center was made aware
6 of the incident, none of the center staff had observed the injury and was not aware the child was injured.
7 During an Interview it was disclosed the injury took place on the play yard earlier that day. It was also
8 disclosed to the director by the child the incident took place outside on the play yard. The child told the
9 teacher during nap time he was bleeding. The teacher made an assessment of the child's mouth and did not
10 observe any visible trauma and sent the child back to this cot. The teacher observed the chipped tooth during
11 the examination, but thought it was already like that. This teacher has been with this child for two weeks prior
12 to the incident.
13
Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Anita Hise

TELEPHONE: (951) 218-7031

LICENSING EVALUATOR SIGNATURE:
DATE: 06/25/2009

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/25/2009

 Control Number 09~CC~200f)061Si65646
STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT (Cont)

INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120
VISIT DATE: 06/25/2009

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
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

The teacher did not ask the child any questions about his mouth, what happened, how did it happen or
where did it happen. Other staff person said the child's tooth was not chipped before that day. There was no
documentation of what the child disclosed to the teacher, nor was this information passed on to the person in
charge of the facility. The facility did admit there was no well ness check done on the child on the morning of
the alleged incident. Therefore, the above allegation(s) have been deemed to be SUBSTANTIATED based
on the preponderance of evidence.

SEE LIC 9099-D FOR THE DEFICIENCY(IES)
An exit interview was conducted, Notice of Site visit posted, appeat rights discussed and given to the
facility representative along with a copy of the report and LIC 9224 was provided as well.

SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Anita Hise

TELEPHONE: (951) 218-7031

LICENSING EVALUATOR SIGNATURE:
DATE: 06/25/2009

I acknowledge receipt of this form and understand my appeal rights as explained and received.

/L -

/1

DATE: 06/25/2009

<A!Qvel\~
UC9099 (FAS)· {06!04)

Page: 2 of3

 Control Number 09-CC-2008061S'I66646
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT (Cont)

INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700

RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120
VISIT DATE: 06/25/2009

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type

POC Due Date I

PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

Type A
0612612009
Section Cited

101229a1

Type A
06/2612009
Section Cited

101212 d 1 c

Type A
0612612009
Section Cited

101223 a 8

1 RESPONSIBILITY FOR PROVIDING CARE AND
2 SUPERVISION: A child was injured and the center
3 staff was not aware the injury took place.
4
5
6
7

1 Licensee will provide CCL with a policy on how visual
2 supervision will be provided to children in care and a
3 sketch of where each teacher is to be located while
4 children are on the play ground will also be provided.

5 The licensee will send in a schedule and names of
6 relieving teachers.
7

1 REPORTING REQUIREMENTS: A child disclosed 1 Licensee will review this section of Title 22 with the
2 an injury to a center staff and the staff did not report 2 staff and discuss what type of incidents are to be
3 the injury to the charge person, complete an unusual
4 incident report for CCL or ouch report to the parent of
5 what was said.
6

3 reported. A sign in sheet with all staff signature
4 indicating this was discussed with them will be
5 provided to CCL

7

7

1 PERSONAL RIGHTS: The child complained of an
2 injury to the mouth and did not receive proper
3 medical care. Other than a visual examination of the

1 Licensee will review this section of Title 22 with the
2 staff and discuss what needs to be done when a child
3 complains of an inJury that may not be seen A sign in

4 mouth no other inquiries to ascertain if the child had
5 in fact been injured. A noticeable chipped tooth was
6 observed.

6

4 sheet with all staff signature indicating this was

7

5 discussed with them will be provided to CCL
6
7

1
2
3

1
2
3

4

4

5
6
7

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: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Anita Hise

TELEPHONE: (951) 218-7031

LICENSING EVALUATOR SIGNATURE:
DATE: 06/25/2009

I acknowledge receipt of this form and understand my appeal rights as explained and received,
FACILITY REPRESENTATIVE SIGNATURE:

ci10r~:0 ~~0JU})
This Notice must be posted for 30 days

DATE: 06/25/2009

 All POC Have Been Cleared
STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CLEARED DEFICIENCIES

INLAND EMPIRE CHILO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER: 364818120

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

VISIT DATE: 02/20/2008
POC Due Date I
Section Number

02/27/2008
1012209(b)(2)

Date Cleared I
Comments

PLAN OF CORRECTIONS(POCs)

1
2 he licensee shall obtain the TB test results for CHILD #4, and
1
02/27/2008
3 ubmit a copy to Licensing by 02/27/08.
2 POC received by the Department on
4
3 02/27/08 (via fax).
5 h-he facility will keep the original TB test results in the child's
4

6 de.
7
02/27/2008

Section Cited
101221(8)(C)

1
2 he licensee shall have the parent sign the Consent for
3 Emergency Medical Treatment form, and submit a copy to
4 Licensing by 02/27/08.

5
6 The facility will keep the original form in the child's file.
7

02/21/2008
1
2 POC received by the Department on
3 02/21/08 (via fax).

4

1

Section Cited

2
3

4

5
6

1
2
3
4

7

Section Cited

1
2
3

4
5
6

1
2
3
4

7
.

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

COMPLAINT INVESTIGATION REPORT

INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visiUinvestigation of a complaint received in our office on
01/06/2009 and conducted by Evaluator Dennis Douglas
COMPLAINT CONTROL NUMBER: 09-CC-20090106095444
FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DOAA SALEEB
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
SAN BERNARDINO
CITY:
STATE:
CAPACITY:
CENSUS: 26
40

UNANNOUNCED
MET WITH:

Alicia Kassens

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME VISIT BEGAN:
TIME COMPLETED:

364818120
850
(909) 319-4884
92406
02/04/2009
02:30PM
04:25PM

ALLEGATION(S):
1 VIOLATION OF CHILDREN'S PERSONAL RIGHTS
2
3 1.) Teachers call children names.

4
5

2.) Teachers pick up children and hold them upside-down.

6
7

3.) Teachers force children to sit.

8
9
INVESTIGATION FINDINGS:
1 On 02/04/09, Licensing Program Analysts (LPAs) Dennis Douglas and Aaron Ross arrived at the facility to
2 conclude the complaint investigation initiated on 01/13/09 concerning the above allegation. During the visit,
3 LPAs toured the facility, and met with Center Director- Alicia Kassens to discuss lhe complaint allegation.
4
5 During the visit, LPA Douglas and LPA Ross interviewed six children and one staff member concerning the
6 above allegations. Per all of the children interviewed, five of them could not recall witnessing any instances of
7 the above allegations ever occurring at the facility. However, one child did recall witnessing some of the
8 allegations occurring (specifically the allegation that Teachers were forcing children to sit).

9
10
11
12
13

Therefore, based on all the information obtained, the allegation is INCONCLUSIVE at this time. Appeal rights
were provided along with a copy of this report.

Inconclusive

Estimated Days of Completion:

SUPERVISOR'S NAME: Marianne Donley

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

~"-•-f

DATE: 02/04/2009

I

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2009

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 {FAS) • (OG/04)

Page: 1 of 2

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

FACILITY NAME: LITILE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DOAA SALEEB
ADDRESS:
2915 N. LITILE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
STATE: CA
CAPACITY:
40
CENSUS: 21
TYPE OF VISIT: Annual/Required
UNANNOUNCED
MET WITH:
Alicia Kassens

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

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

INLAND EMPIRE CHILO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 319-4884
92406
01/13/2009
08:45AM
03:45PM

NARRATIVE
Licensing Program Analyst (LPA), Aaron Ross and Dennis Douglas conducted a
comprehensive annual visit. LPA toured the facility, took census and met with Director,
Alicia Kassens.
• A review of 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

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951 )782-4970

LICENSING EVALUATOR NAME: Aaron Ross

TELEPHONE: (951 )-233-7183

LICENSING EVALUATOR SIGNATURE:

~~

DATE: 01/13/2009

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2009

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 {FA$) • (06/04)

Page: 1 of 3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 01/13/2009

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

• 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.
• A review of staff records on 01/13/09 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 following civil penalty information was discussed: If a facility is cited for a serious deficiency
and then repeats the same violation within a 12 month period, an immediate penalty of $150
shall be assessed and a penalty of $50 per day shall be assessed until the deficiency is
corrected. If the facility repeats the same violation for a third time within the same 12 month
period, the facility will be cited and assessed an immediate penalty of $150 for that day and
$150 per day until the deficiency is corrected. The facility representative was advised how to
access forms and regulations for Child Care Centers online at www.dss.cahwnet.gov or
ccld.ca.gov
• The facility representative was notified that violations of the sections pertaining to Parent's
Rights sections 1 01218.1{b){8), {c), (d), (e), (e)(1), or (e)(2) are subject to three tier civil
penalties.
• 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.
• A review of resident and/or staff records on 01/13/09 indicates that all facility staff or other
individuals who require caregiver background checks have received criminal record and child
abuse index clearances or exemptions.
• Whenever a Type A deficiency is cited, LPAs shall explain the notification requirements of
AB 633 noting that upon receipt, 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. See LIC809D for cited deficiencies.
An exit interview was conducted, appeal rights discussed and a copy of this report was provided.
A copy of this report must be made available to the public, at the facility site, for 3 years.

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951 )782-4970

LICENSING EVALUATOR NAME: Aaron Ross

TELEPHONE: (951 )-233-7183

LICENSING EVALUATOR SIGNATURE:

~~~

DATE: 01/13/2009

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2009

 STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I

FACILITY NUMBER: 364818120
VISIT DATE: 01/13/2009
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES

Section Number

Type B
01/14/2009
Section Cited

101238(a)

1
2
3
4
5
6
7

1 The Licensee shall ensure that the facility is clean
2 and sanitary. LPA's will return at a later date to
3 ensure that the deficiency has been corrected.
shells. LPA's informed Ms Kassens that the facility 4
5
must be clean, sanitary and in good repair at all
6
times.
7

1
2
3
4
5
6
7

1
2
3

BUILDING AND GROUND: The facility was not

clean and sanitary. LPA's observed dirt on floors,
cob webs, and wood chips inside the window

4

5
6
7

1

1

2

2

3
4
5
6
7

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: Tammy J. McMichael-Peirce

TELEPHONE: (951)782-4970

LICENSING EVALUATOR NAME: Aaron Ross

TELEPHONE: (951 )-233-7183

LICENSING EVALUATOR SIGNATURE:

~~

DATE: 01/13/2009

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2009

LIC809 (FAS) • (06104)

Page: 3 of3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/11/2008 and conducted by Evaluator Dennis Douglas
COMPLAINT CONTROL NUMBER: 09-CC-20081211134951
FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
FACILITY NUMBER:
FACILITY TYPE:
ADMINISTRATOR; DOAA SALEEB
2915 N. UTILE MOUNTAIN DRIVE
ADDRESS:
TELEPHONE:
CITY:
SAN BERNARDINO
ZIP CODE:
STATE:
CAPACITY:
40
CENSUS: 21
DATE:
UNANNOUNCED TIME VISIT BEGAN:
MET WITH:
Alicia Kassens
TIME COMPLETED:

364818120
850
(909) 319-4884
92406
01/13/2009
08:45AM
03:45PM

ALLEGATION($):
1 Lack of supervision- child left unsupervised

2
3
4
5
6
7
8
9
INVESTIGATION FINDINGS:
1 On 01/13/09, Licensing Program Analysts (LPA's) Dennis Douglas and Aaron Ross arrived at the facility to
2 conclude the complaint investigation initiated on 12/22/08. During the visit on 01/13/09, the LPAs took a
3 census of the children present, and met with Center Director- Alicia Kassens to discuss the complaint
4 allegation.

5
6
7
8
9
10
11
12
13

During the visit, LPA Douglas and LPA Ross interviewed several staff members concerning the above
allegation. Based on all the information obtained, the following was disclosed: The complaint alleged that a
child was left in the hallway unsupervised by staff. However, per interviews with staff members none could
recall a incident when a child was left in the hallway unsupervised. There were also no incident reports
documenting the alleged incident.
Therefore, due to conflicting information the above allegation is INCONCLUSIVE at this time. An exit interview
was held. Appeal rights along with a copy of this report was provided at the time of visit.

Inconclusive

Estimated Days of Completion:

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

.... ;:, £>4.-'~a

LICENSING EVALUATOR SIGNATURE:

a~

DATE: 01/13/2009

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

~~

DATE: 01/13/2009

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) • (06/04)

Page: 1 of 2

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

Inland Empire CC, 3737 Main 5treet#700
Riverside, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
FACILITY NUMBER:
ADMINISTRATOR: DOAA SALEEB
FACILITY TYPE:
ADDRESS:
2915 N. LITTLE MOUNTAIN DRIVE
TELEPHONE:
CITY:
ZIP CODE:
SAN BERNARDINO
STATE:CA
DATE:
CAPACITY:
40
CENSUS: 25
UNANNOUNCED TIME BEGAN:
TYPE OF VISIT:
Case Management
MET WITH:
Alicia Kassens
TIME COMPLETED:

1
2
3
4

364818120
850
(909) 319-4884
92406
09/15/2008
09:30AM
11:15AM

NARRATIVE
On visit 9/10/08, it was noted that employee Ella L. Theus did not have criminal record clearances associated
to this facility. This is the 2nd violation in 12 months.
See Lie 9099(D) for deficiencies.

5
6

7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

An exit interview was conducted a copy of this report was provided and a notice of site visit was
posted and must remain posted for 30 days. Removal of posting is subject to a $100 civil penalty.
Upon receipt, 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 for
the next 12 months.

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Dale Sadler

TELEPHONE: (951) 233-3964

LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2008

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

~~

DATE: 09/15/2008

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LlC809 (FAS) • (06104)

Page: 1 of 2

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

Inland Empire CC, 3737 Main Street#7DO
Riverside, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I
Section Number

Type A
09/15/2008
Section Cited

101170

FACILITY NUMBER: 364818120
VISIT DATE: 09/15/2008

DEFICIENCIES
1
2
3
4
5
6
7

,

PLAN OF CORRECTIONS(POCs)

On visit 9/10/08, it was noted that employee Ella L. 1 Corrected at this time.
2
3
4
5
6
7

Theus did not have criminal record clearances
associated to this facility. This is the 2nd violation
in 12 months.

2
3
4
5
6
7

,

1
2
3
4
5
6
7
1
2
3
4
5

2
3
4
5
6
7

7

1
2
3
4
5
6
7

1
2
3
4
5
6
7

6

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: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4200

LICENSING EVALUATOR NAME: Dale Sadler

TElEPHONE: (951) 233-3964

LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2008

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2008

This Notice must be posted for 30 days
LICBD9 (FAS) • {06/04)

Page: 2 of 2

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CIVIL PENALTY ASSESSMENT -IMMEDIATE

Inland Empire CC, 3737 Main Street#7DO
Riverside, CA 92501

DATE

FACILITY NAME

09/15/2008

LITTLE MOUNTAIN PRESCHOOL
CITY

FACILITY ADDRESS

SAN BERNARDINO

2915 N. LITTLE MOUNTAIN DRIVE
ZIP CODE

STATE

92406

CA
FACILITY NUMBER

LICENSEE(S)/OPERATOR

364818120

ROHITH A. SENEWIRATNE

Immediate civil penalties can be assessed against any licensee for fallure to comply w1th cnminal background check requirements and
against family child care licensees for failure to comply with parenVguardian notification and visit report posting requirements. See the
back of this form for specifics.

On this date you have been found in violation of one or more requirements for which an immediate civil penalty is warranted. See the
Facility Evaluation Report (LIC 809) issued on this date. You are hereby notified that a civil penalty has been assessed.
$100 immediate Civil Penalty per person for allowing any person (who is subject to a background check) to work, reside or
D x volunteer
without a criminal record clearance or exemption. Maximum 5 days for first violation.

[g)

$100 immediate Civil Penalty per person for allowing any person (who is subject to a background check) to work, reside or
x volunteer without a criminal record clearance or exemption. Maximum of 30 days for subsequent violations.

0 ·$100 immediate Civil Penalty per person for allowing a cleared or exempted person to wo:-k, reside or volunteer before
x requesting a clearance transfer or before receiving approval of an exemption transfer.

D

$100 immediate Civil Penalty per parenVauthorized representative for failure to provide "Family Child Care Home Addendum to
x Notification of Parents' Rights (Regarding Exclusion)".

D

$100 immediate Civil Penalty per parenVauthorized representative for failure to provide "Family Child Care Home Addendum to
x Notification of Parents' Rights (Regarding Reinstatement)".

0

x $100 immediate Civil Penalty per parenUauthorized representative for failure to obtain signature indicating receipt of Addendum.

D x $100 immediate Civil Penalty for failure to provide signed addendum to the Department when requested.

0

x $100 immediate Civil Penalty for failure to post the "Notice of Site Visit Report" for 30 consecutive days.
Individual #1

Ella Theus

number of days

30

X S1 00 =

S3,000.00

Penally

Individual #2

number of days

X S100 =

$0.00

Penalty

Individual #3

number of days

X $100 =

$0.00

Penalty

$3,000.00

Total

YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL!
NAME OF LICENSING PROGRAM ANALYST Dale Sadler
SIGNATURE OF LICENSING PROGRAM ANALYST

NAME OF FACILITY REPRESENTATIVE/TITLE
SIGNATURE OF FACILITY REPRESENTATIVE

SUPERVISOR REVIEW SIGNATURE (FOR INTERNAL USE ONLY)

DATE 09/15/2008
TITLE

UC421 B {FAS) • (05/0G)

Page: 1 of 2

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

Inland Empire CC, 3737 Main SlrcH!I Suite 700
Riverside, Ca, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR: DOAA SALEEB
ADDRESS:
N LITTLE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
CAPACITY:
40
TYPE OF VISIT: Case Management
MET WITH:
Laura Winger

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

STATE:CA
CENSUS: 16
UNANNOUNCED

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 319-4884
92406
08/12/2008
08:30AM
12:15 PM

NARRATIVE
On 08/12/08, Licensing Program Analyst Dennis Douglas arrived at the facility to conduct a
required visit per a non compliance conference held in the district office on 10/09/07. During
the visit, LPA Douglas took census, toured facility, and observed children engaged in age
appropriate indoor and outdoor activities.
• A review of 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

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

~ ...

'1

DATE: 08/12/2008
J

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

~uu/~

DATE: 08/12/2008

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Page: 1 of 3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

Inland Empire CC, 3737 Main Street Suite 700
Riverside, Ca, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 08/12/2008

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

• The licensee has been informed that all employees must be associated to the facility.
An immediate assessment of civil penalties in the amount of $100 per violation, per day, for a
maximum of 5 days, or for a maximum of 30 days in the case of a 2nd or subsequent violation, and
by providing that a violation is grounds for denying an application for, or suspending or revoking, a
license or administrator certificate.
• A review of staff records on 08/12/08 indicates that not all facility staff or other individuals who
require caregiver background checks have received criminal record and child abuse index
clearances or exemptions.
• The following civil penalty information was discussed: If a facility is cited for a serious deficiency
and then repeats the same violation within a 12 month period, an immediate penalty of $150 shall
be assessed and a penalty of $50 per day shall be assessed until the deficiency is corrected. If the
facility repeats the same violation for a third time within the same 12 month period, the facility will be
cited and assessed an immediate penalty of $150 for that day and $150 per day until the deficiency
is corrected. The licensee was advised how to access forms and regulations for Child Care Centers
online at www.dss.cahwnet.gov or ccld.ca.gov
• The new "Notification of Parent's Rights" (PUB393) poster was provided and the licensee was
advised that it must be posted in an area of the facility accessible to parents. The information
regarding new legislation with regards to exemptions and Parent's Rights was also provided.
• The licensee was notified that violations of the sections pertaining to Parent's Rights sections
101218.1 (b )(8), (c), (d), (e), (e)(1 ), or (e )(2) are subject to three tier civil penalties.
The following was reviewed with the licensee(s):
- AB 633- Parent Notification Requirements effective January 1, 2007 -Whenever a Type A
deficiency is cited, upon receipt, the 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.
See LIC809D for cited deficiencies in accordance with the California Code of Regulations
Title 22, Division 12.
An exit interview was conducted, appeal rights discussed and a copy of this report was provided.

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

~

_3

/

""':(:(VA-- .. ,. •:&<..,.

.J

~~

g , ...,

7:::fllJ9'i~
..~~oli--~

DATE: 08/12/2008

I acknowledge receipt of this form and understand my appeal rights as explained and received.

DATE: 08/12/2008

LIC809 (FAS) ~ (06/04)

Page; 2 of J

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

Inland Empire CC, 3737 Main Street Suitt! 700
Riverside, Ca, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I
Section Number

Type A
08/12/2008
Section Cited
101170

FACILITY NUMBER: 364818120
VISIT DATE: 08/12/2008
PLAN OF CORRECTIONS(POCs)

DEFICIENCIES
1
2
3
4
5
6

1 During the visit on 08/12/08, the facility faxed a
CRIMINAL RECORD CLEARANCES: Staff
member, JESSICA ACOSTA, had been fingerprint 2 "Criminal Background Clearance Transfer Request"
cleared through Livescan, however, the facility did 3 form to Licensing associating JESSICA ACOSTA's

7

4 fingerprint clearance to their facility.
5
6 No correction needed.
7

1
2
3
4
5
6
7

1
2
3
4
5
6
7

1
2

1
2

3
4
5
6
7

3
4
5
6
7

1
2
3
4
5
6

1
2
3
4
5
6

7

7

not associate her clearance to their facility.

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: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

~~~·~4

.,.

DATE: 08/12/2008

I acknowledge receipt of this form and understand my appeal rights as explained and received.

DATE: 08/12/2008

This Notice must be posted for 30 days
LIC809 (FAS) • (06104)

Page: 3 of3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

Inland Empire CC, 3737 Main Street Suite 700
Riverside, Ca, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR:SENEWIRATNE, ROHITH
ADDRESS:
N LITTLE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
CAPACITY:
40
TYPE OF VISIT: Annual/Required
MET WITH:
Doaa Saleeb

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

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

STATE:CA
CENSUS: 25
UNANNOUNCED

364818120
850
(909) 319-4884
92406
02/2012008
11:15AM
03:20PM

NARRATIVE
On 02/20/08, Licensing Program Analyst Dennis Douglas arrived at the facility to conduct a
required visit per a non compliance conference held in the district office on 10/09/07. During
the visit on 02/20/08, LPA Douglas took census, toured facility and observed the children
engaging in age appropriate indoor activities.
• A review of 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. LJC 500 Personnel Report
2. LJC 610 Emergency & Disaster Plan
3.Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule
(only if changes have been made)
4.LJC 309 Administrative Organization (only if changes have been made)
5.LJC 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

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

-

'tlt#~•• ;.c.~ ~ "~d

DATE: 02120/2008

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

;

liP

DATE: 02120/2008

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Page: 1 of 3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNilY CARE LICENSING OJVJSJON

FACILITY EVALUATION REPORT (Cont)

Inland Empire CC, 3737 Main Stroot Suite 700
Riverside, Ca, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 02/20/2008

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

• The licensee has been informed that all employees must be associated to the facility.
An immediate assessment of civil penalties in the amount of $100 per violation, per day, for a
maximum of 5 days, or for a maximum of 30 days in the case of a 2nd or subsequent violation, and
by providing that a violation is grounds for denying an application for, or suspending or revoking, a
license or administrator certificate.
• A review of staff records on 02/20/08 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 following civil penalty information was discussed: If a facility is cited for a serious deficiency
and then repeats the same violation within a 12 month period, an immediate penalty of $150 shall
be assessed and a penalty of $50 per day shall be assessed until the deficiency is corrected. If the
facility repeats the same violation for a third time within the same 12 month period, the facility will be
cited and assessed an immediate penalty of $150 for that day and $150 per day until the deficiency
is corrected. The licensee was advised how to access forms and regulations for Child Care Centers
online at www.dss.cahwnet.qov or ccld.ca.gov
• The new "Notification of Parent's Rights" (PUB393) poster was provided and the licensee was
advised that it must be posted in an area of the facility accessible to parents. The information
regarding new legislation with regards to exemptions and Parent's Rights was also provided.
• The licensee was notified that violations of the sections pertaining to Parent's Rights sections
101218.1(b)(8), (c), (d), (e), (e)(1), or (e)(2) are subject to three tier civil penalties.
The following was reviewed with the licensee(s):

- AB 633- Parent Notification Requirements effective January 1, 2007 -Whenever a Type A
deficiency is cited, upon receipt, the 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.
See LIC809D for cited deficiencies in accordance with the California Code of Regulations
Title 22, Division 12.
An exit interview was conducted, appeal rights discussed and a copy of this report was provided.

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

9'4u;;

DATE: 02/20/2008

I

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

& #f! za<)i§
LIC809 (FAS)· (06104)

'

DATE: 02/20/2008

Page: 3 of :3

 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

Inland Empire CC, 3737 Main Street Sulto70D
Riverside, Ca, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:

FACILITY NUMBER: 364818120
VISIT DATE: 02/20/2008

Deficiency Type

POC Due Date I

DEFICIENCIES

PLAN OF CORRECTIONS(POCs)

Section Number

TypeS
02/27/2008
Section Cited

1012209(b)(2)

Type B
02/27/2008
Section Cited

101221 (8)(C)

1 CHILD'S MEDICAL ASSESSMENTS: Per review
2 of random children's files, LPA discovered that TB
3 test results were not present in CHILD #4's file.
4
5
6
7

1
2
3
4
5
6
7

The licensee shall obtain the TB test results for
CHILD #4, and submit a copy to Licensing by

1
2
3
4
5
6
7

1
2
3
4
5
6
7

The licensee shall have the parent sign the
Consent for Emergency Medical Treatment form,
and submit a copy to Licensing by 02/27/08.

CHILD'S RECORDS: Per review of random
children's files, LPA discovered that a signed
Consent for Emergency Medical Treatment form
was not present in CHILD #4's file.

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

02/27/08.
The facility will keep the original TB test results in
the child's file.

The facility will keep the original form in the child's
file.

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: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

~""""{ (.1 g,,~---

DATE: 02/20/2008

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

'53 a J:::ZSzzluJc:>
LIC809 (FAS) • (06/04)

DATE: 02/20/2008

Page: 2 of 3

 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

STATE OF CAUFORNIA ·HEALTH AND HUMAN SERVICES AGENCY

Inland Empire CC
3737 Main Street Suite 700
Riverside, Ca, CA 92501

01/09/2008
UTILE MOUNTAIN PRESCHOOL

364818120
2419 HEAVENLY WAY
CORONA, CA 92881
Letter of Deficiency Citations Cleared
Dear Licensee,
The following deficiencies, initially cited during a visit on 09/07/2007, have been cleared:
Section Cited: 101238 (a)
Plan of Correction:

Date Due: 09/10/2007
Corrections:

The Center Director stated that both toilets will be repaired by
09/10/07. An LJC 9098 "Proof of Correction" form will be faxed to
Licensing certifying that the repairs have been made.

On 09/10/07, Licensing received a
signed LIC9098 from the facility
certifying that the toilets have been
repaired.

LICENSING EVALUATOR NAME: Dennis Douglas

Clearance Date:
09/10/2007

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

~~-~/

DATE: 01/09/2008

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Cleared POC Letter {FAS)· (04/05)

Page: 1 of 1

 All POC Have Been Cleared
STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CLEARED DEFICIENCIES

Inland Empire CC, 3737 Main Street Suite 700
Riverside, Ca, CA92501

FACILITY NUMBER: 364818120

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL

VISIT DATE: 09/07/2007
POC Due Date I

PLAN OF CORRECTIONS(POCs)

Date Cleared I
Comments

Section Number

0911012007
101238 (a)

1
; The Center Director stated that both toilets will be repaired by
4 09110/07. An LIC 9098 "Proof of Correction" form will be
5 faxed to Licensing certifying that the repairs have been made.

6
7
8
9
10
11
12
13
14

Section Cited

1
2
3
4

5
6

1

0911012007
On 09/10/07, Licensing received a signed
2
LIC9098 from the facility certifying that
3
4 the toilets have been repaired.

1
2

3
4

1
2
3
4

7

Section Cited

1
2
3
4

5
6
7

1
2
3
4

 STATE OF,.•· 0
'""'-~F RNIA • HEALTH ANO HUMAN SERVICES AGENCY

CAl.!F'OONJA DEPARTMENT OF COCIA.L. SERVICES

COMMUNITY CARE LICENSING D1VIG10N

PROOF OF CORRECTION

Inland Ernpi,. cc, J73T Main srreor Sullf 700

Rlven;ldo, Ca, CA P2J01

FACJUTY NAME:

FACILITY NUMBER:

LITTLE MOUNTAIN PRESCHOOL

LICENSING EVAWATOR:

364818120

Dennis Douglas

This form Shall be used in conjunction wnh the Licensing Report (UC 809) and is provided to the facility
correction of deflciency(ies) cited in a :icensing visit to your facility on

to verify the

09/07/2007. The use of this form will not

prohibit the Licensing Evaluator from conducting follow-up visits to ensure that deficiencies are conrected.

(See

instructions on page 2).

PROOF OF CORRECTION
DEFICIENCY(!~~~

SECTION
1.

NUMB~

77f7-;:; 3X

PICTURE RECEIPT PHOTO· "CERTIFICATION OTHER
I COPY

v

DATE
COfSRECJ;EO

I

2.

3.
4.

5.
6.
7.

8.
9.
I certify, under penalty of pe~ury under the laws of the State of California, that the above is true and correct and that
I have corrected all deficiencies above on or before the date(s) indicated.

•certification • this box
y be checked if there is no other means to verify that the deficiency as bee corrected.
By signing this form, the licensee is self-certifying that the corrections have been made. If the certification is related
to fingerprints, include the name(s) of the individual(s) for which the fingerprint card was submitted and insert the
date submitted to the Department of Justice in the "Data Corrected" column.

PLEASE RETURN THIS FORM WITH YOUR PROOF OF CORRECTION($)

LICSOOO !FAS) • {3100)

SEP 10 2007 18:43

Page: 1 of2

9093194884

PAGE.02

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

Inland Empire CC, 3737 Main Street Suite 700
Riverside, Ca, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL
ADMINISTRATOR:SENEWIRATNE, ROHITH
ADDRESS:
N UTILE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
40
CAPACITY:
TYPE OF VISIT:
Case Management· Incident
MET WITH:
Amanda Carter

1
2
3
4

STATE:CA
CENSUS: 30

UNANNOUNCED

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 319-4884
92406
09/07/2007
01:00PM
02:30PM

NARRATIVE
On 09/07/07, LPA Douglas conducted a case management visit to address to following issue: LPA Douglas
observed that two toilets at the facility are inoperable.
(SEE 809D FOR DEFICIENCY CITED)

5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

An exit interview was held with Center Director. Amanda Carter. Appeal rights were provided along with a
copy of this report.

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

~. <;; f ~ t;

:t&a

DATE: 09/07/2007
'

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

0

DATE: 09/07/2007

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 2

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

Inland EmpltG CC, 3737 Main Street Suite 700
RlllarsldG, Ca, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:

FACILITY NUMBER: 364818120
VISIT DATE: 09/07/2007

Deficiency Type
POC Due Date I
Section Number

DEFICIENCIES

Type A
09/10/2007
Section Cited
101238 (a)

1 BUILDINGS AND GROUNDS: Two of the toilets at
2 the facility are inoperable.
3
4
5
6
7

1
2
3
4
5
6
7

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

PLAN OF CORRECTIONS(POCs)
The Center Director stated that both toilets will be
repaired by 09/10/07. An LIC 9098 "Proof of
Correction" form will be faxed to Licensing
certifying that the repairs have been made.

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: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

a-.L~ ~ ~#/ '-'i1:r~

DATE: 09/07/2007

#

I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

~~

DATE: 09/07/2007

This Notice must be posted for 30 days
LIC809 (FAS) • (06104)

Paga: 2 of 2

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

NONCOMPLIANCE CONFERENCE SUMMARY

Inland Empire CC, 3737 Main Street Suite 700
Riverside, Ca, GA 92501

NAME AND ADDRESS OF FACILITY:

LITTLE MOUNTAIN PRESCHOOL
N LITTLE MOUNTAIN DRIVE
SAN BERNARDINO, CA 92406
EFFECTIVE D~TE OF LICENSE.

FACILITY LICENSE NUMBER

364818120

LICENSE CAPACITY

40

02113/2007

FAGILITY TYPE·

STATUS

6

850

LICENSEE NAME(S).

ROHITH A SENEWIRATNE
NAME AND FACILITY NUMBER OF OTHER COMMUNITY CARE, CHILD DAY CARE, RESIDENTIAL CARE
FACILITIES FOR THE ELDERLY, OR HEALTH FACILITIES LICENSED TO OR OWNED BY APPLICANT(S)
WITHIN THE LAST FIVE YEARS.
FACILITY NAME

A
B.

c.

FACILITY NUMBER

Little Mountain Preschool
Little Mountain Preschool

364818121
364818122

D.

E.
F.
DATE OF CONFERENCE:

10/09/2007

LICENSING PROGRAM ANALYST:

LICENSING PROGRAM MANAGER:

Dennis Douglas

Present at meeting:
NAME

TITLE

Tammy McMichael-Peirce
Marianne Donely
Dennis Douglas
Rohith Senewiratne
Amanda Carter
Lilamani Senewiratne

Licensing Program Manager
Licensing Program Manager
Licensing Program Analyst
Licensee
Center Director
Licensee's Wife

UC9111 (FAS) • (12/99) ·{PUBLIC)

Page: 1 or

 STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

NONCOMPLIANCE CONFERENCE SUMMARY- PAGE 2 '"''"' empr,.cc. 3737 M,,,.,,,.,.,,, '"
Riverside, Ca, CA 92501

NAME AND ADDRESS OF FACILITY·

LITTLE MOUNTAIN PRESCHOOL
N LITTLE MOUNTAIN DRIVE
SAN BERNARDINO, CA 92406
FACILITY LICENSE NUMBER.

364818120

EFFECTIVE DATE OF LICENSE.

02/13/2007

LICENSE CAPACITY:

FACILITY TYPE:

STATUS

40

850

6

LICENSEE NAME(S):

ROHITH A. SENEWIRATNE
This Noncompliance Conference was called to discuss the following issues or deficiencies:
1 A Noncompliance Conference was held in the Inland Empire Child Care Regional Office with Tammy
2 McMichael-Peirce, Licensing Program Manager, Marianne Donley, Licensing Program Manager,
3 Dennis Douglas, Licensing Program Analyst, Licensee, Rohith Senewiratne, and Center Director,
Amanda Carter.

i

~ The purpose of this meeting is to address the concerns associated with facility's history, which include:
8 commingling, violating the terms of the license, and inoperable equipment.
9
10 To prevent future occurrences, the licensee(s) has agreed to the following compliance plan:
11
.
LICENSEE'S COMPLIANCE PLAN

12
13

i~ Licensee,

Rohith Senewiratne agrees to operate the facility in full compliance with Title 22 and Health

16 & Safety Code requirements with particular attention to the following sections: 101438.3 INDOOR

17 ACTIVITY SPACE FOR INFANTS, 101239 FIXTURES, FURNITURE, EQUIPMENT AND SUPPLIES,
18 and 101182 ISSUANCE/TERM OF A LICENSE. Any further violation of these laws and regulations
19 may result in initiation of proceedings to revoke the Little Mountain Preschool license.
20
21 • The facility will receive unannounced visits from Licensing for the next 24 months. This is to monitor
~~the progress of this plan and provide consultation as needed to help the licensee with successful
24 completion.
25
26 The Department will monitor the licensee's compliance over the next 24 months (to expire in 10/2009)
27 to determine if the licensee is able to remain in compliance with Licensing laws and regulations. The
28 licensee understands and acknowledges that the Department, at its discretion, will make unannounced
29 visits to monitor the compliance of the facility. If the Department determines that the licensee has
30 violated the law or regulations it may refer the facility for revocation or other appropriate administrative
31 acrron.
32
As the licensee, I understand and will comply with the plan of action described on this form.
LICENSEE SIGNATURE

DATE:

10/09/2007

MANAGER SIGNATURE:

~~v)'rk~dd ~~
LIC~111

(FAS) • (12/99) ·(PUBLIC)

DATE:

10/09/2007

Page: 1 of

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

NONCOMPLIANCE CONFERENCE SUMMARY- PAGE 3 '"''""Emp"occ,3737M•'"s""'s""'"'
Riverside, Ca, CA 92501
NAME AND ADDRESS OF FACILITY:

LITTLE MOUNTAIN PRESCHOOL
N LITTLE MOUNTAIN DRIVE
SAN BERNARDINO, CA 92406
FACILITY LICENSE NUMBER:

364818120

EFFECTIVE DATE OF LICENSE:

02/13/2007

LICENSE CAPACITY:

FACILITY TYPE:

STATUS:

40

850

6

LICENSEE NAME(S):

ROHITH A. SENEWIRATNE

Licensee agreed to do the following in order to bring the facility into compliance no later than the following dates:
1
IMMEDIATELY
2

1

Licensee, Rohilh Senewiratne agrees to operate the facility in full compliance with Title 22 and Health
& Safety Code requirements with particular attention to the following sections: Indoor Activity Space
~ For Infants, Fixtures, Furniture, and Equipment, Issuance/Terms of a License. Any further violation of
7 these laws and regulations may result in initiation of proceedings to revoke the Child Care Center
8 license.
9
10 • The facility will receive increased unannounced visits from Licensing for the next 24 months. This is
~ not to be considered probation, either formal or informal. The Department may at its discretion
review this case with its legal consultant for possible administrative action.
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29

i

30
31
32

As the licensee, I understand and will comply with the plan of action described on this form.
LICENSEE SIGNATURE

DATE:

~
MANAGER SIGNATURE:

~/n.v~~
LIC9111 (FAS)· (12/99)· (PUBLIC)

10/09/2007

DATE:

10/09/2007

Page: 1 of

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

NONCOMPLIANCE CONFERENCE SUMMARY- PAGE 4'"''"'"m''"cc,m7M''"s'""s"'"'"
Riverside, Ca, CA 92501
NAME AND ADDRESS OF FACILITY

LITILE MOUNTAIN PRESCHOOL
N LITILE MOUNTAIN DRIVE
SAN BERNARDINO, CA 92406
FACILITY LICENSE NUMBER:

EFFECTIVE DATE OF LICENSE:

364818120

LICENSE CAPACITY:

02/13/2007

FACILITY TYPE:

STATUS:

6

40

850

LICENSEE NAME(S):

ROHITH A. SENEWIRATNE

Licensee has been advised that failure to complete the above agreed upon actions by the dates will result in this
Department taking the following action(s):
1 In the event that legal action is taken, nothing in this plan precludes the Department from including the
2 above issues.
3

ci • Effective January 1, 2007 the licensee must comply with AB 633 as follows:
6

7 Upon receipt by the licensee, the licensee is to provide to parents/guardians the following:
8
9 Copies of any licensing report that documents a Type A citation -this includes facility visits and
10 substantiated complaint investigations.
11
12 Copies of any licensing documents pertaining to a noncompliance conference between licensing
13 management and licensees.

~~Copies of a summary of an

accusation indicating the Department's intent to revoke the facility's
license.
16
17 Copies of any of the above licensing documents the licensee has received in the prior 12 months shall
~~be provided to parents/guardians of newly enrolling children.
20
21 The licensee shall keep verification of receipt in each child's file at the facility.

22
23
24
25
26
27
28
29
30

0

A detailed letter regarding this conference will be mailed to the licensee within 5 calendar days.

As the licensee, I understand and will comply with the plan of action described on this form.
DATE:

10/09/2007
/

MANAGER SIGNATURE.

DATE:

10/09/2007

LIC9111 (FAS) • {12199) ·(PUBLIC)

Pagn: 1 of

 STATE OF CALIFORNIA·· HEALTH AND

HU~.

ERVICES AGENCY

ARNOLD SCHWARZENEGGER. GOVERNOR

DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
3737 Main Street, Suite 700
Riverside, CA 92501
(951) 782-4200

September 24, 2007
Little Mountain Preschool
2915 N. Little Mountain Dr.
San Bernardino, Ca. 92406
Facility Number: 364818120
Dear Rohith Senewiratne:
This letter is to advise you that a Non-Compliance conference has been scheduled for
October 9, 2007 at 1O:OOam in the Inland Empire Child Care Office with Marianne
Donley, Regional Manager(a), Tammy Me Michaei-Peirce, Licensing Program Manager,
and Dennis Douglas Licensing Program Analyst.
Your attendance at this conference is mandatory. You may bring someone with you to
participate in this conference (e.g. another provider, provider association representative,
etc.). The conference will focus on the following issue:

1. Commingling
2. Fixtures, Furniture, and Equipment
3. Buildings and Grounds
It is requested that you notify our office if date and/or time of conference require
rescheduling. Also if you plan to bring someone with you to this conference please
advise us as soon as possible. Please note that children are not allowed at this
conference.
Sincerely,

~7ft~~~~
;AMMfMcMICHAEL-PEIRCE
Licensing Program Manager
Inland Empire Child Care

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DJVJSJON

FACILITY EVALUATION REPORT

Inland Empire CC, 3737 Main Street Suite 700

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR:SENEWIRATNE, ROHITH
ADDRESS:
N LITTLE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
CAPACITY:
40
TYPE OF VISIT: Case Management - Incident
MET WITH:
Amanda Carter

1
2

Riverside, Ca, CA 92501

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
STATE:CA
ZIP CODE:
CENSUS: 30
DATE:
UNANNOUNCED TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 319-4884
92406
09/07/2007
01:00PM
02:30PM

NARRATIVE
On 09/07/07, LPA Douglas conducted a case management visit to address to following issue: LPA Douglas
observed that two toilets at the facility are inoperable.

3
4
5
6
7

(SEE 8090 FOR DEFICIENCY ClEO)
An exit interview was held with Center Director- Amanda Carter. Appeal rights were provided along with a
copy of this report.

8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

g~

do< f

f ~:6:~~r;...~_e.~
r1

.....,,.,. DATE: 09/07/2007
11111

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

D

DATE: 09/07/2007

This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) • (06/04)

Page: 1 of2

 STATE OF CAliFORNIA· HEAlTH AND HUMAN SERVICES AGENCY

CAliFORNIA DEPARTMENT OF SOCIAl SERVICES
COMMUNITY CARE liCENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

Inland Empire CC, 3737 Main Street Sullc 700
Riverside, Ca, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
DEFICIENCY INFORMATION FOR THIS PAGE:
Deficiency Type
POC Due Date I
Section Number

Type A
09/10/2007
Section Cited
101238 (a)

FACILITY NUMBER: 364818120
VISIT DATE: 09/07/2007

DEFICIENCIES

PLAN OF CORRECTIONS(POCs)

1 BUILDINGS AND GROUNDS: Two of the toilets at 1 The Center Director stated that both toilets will be
2 the facility are inoperable.
2 repaired by 09/10107. An LIC 9098 "Proof of
3
3 Correction" form will be faxed to Licensing
4
4 certifying that the repairs have been made.
5
5
6
6
7
7
8
9
10
11
12
13
14

8
9
10
11
12
13
14

1
2
3

1
2
3
4
5
6

4

5
6
7

7

1
2
3

1
2
3
4
5
6
7

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: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 782-4953

LICENSING EVALUATOR SIGNATURE:

':2:1~

....

-m

1;/

DATE: 09/07/2007

FACILITY REPRESENTATIVE SIGNATURE:

~~

DATE: 09/07/2007

This Notice must be posted for 30 days
UC809 (FAS) • (06/04)

Page: 2 of 2

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

Inland Empire CC, 3737 Main Street Sulle 700
Riverside, Ca, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR:SENEWIRATNE, ROHITH
ADDRESS:
N. LITTLE MOUNTAIN DRIVE
CITY:
SAN BERNARDINO
40
CAPACITY:
TYPE OF VISIT: POC
MET WITH:
Rohith Senewiratne

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

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
STATE:CA
CENSUS: 0
DATE:
UNANNOUNCED TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 319-4884
92406
02/09/2007
09:00AM
12:15 PM

NARRATIVE
On 02/09/07, Licensing Program Analysts (LPA's) Dennis Douglas and Eugene Garcia arrived at the
facility to conduct a Plan of Correction (POC) visit for the purposed combination center. The purpose
of the visit was to follow-up on the corrections that needed to be made to the facility per previous
pre-licensing visit conducted by LPA Douglas on 02/05/07 (refer to LIC809 dated 02/05/07). The
following measurements were also taken by LPA Douglas and LPA Garcia during the POC visit:
Preschool indoor Activity Areas
Room #2: 22.2 x 28.0 - 621.6 sq It
Room #3: 16.2 x 29.5 477.9 sg It
Room #4: 18.4 x 20 = 368 sg ft
Room #6: 18.4 x 22.5 = 414 sq ft
Room #8: 17.5 x 26.1 + 17.5 x 21.6 834.75 sg ft
Room #9: 10.6 x 15.0 = 159 sq It
Total indoor activity space: 2875.25 divided by 35 = 82 children

=

=

Preschool Bathroom Fixtures
5 toilets and 5 urinals (one of each in five of the six total classrooms) x 15
5 sinks (one in five of the six total classrooms) x 15 75 children

=

= 75 children

Preschool Outdoor Activity Area: 147 x 39.10 = 5747.7 sq It
Total outdoor activity space: 5747.7 sq. ft. divided by 75
76 children

=

Limiting factor for preschool capacity is the licensee's request. Preschool capacity is limited to
40 children.
(CONTINUED)

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 320-7464

LICENSING EVALUATOR SIGNATURE:

am6'dr ~ Q;c:¢<

DATE: 02/09/2007

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

DATE: 02/09/2007

This report must be available at Child Care and Group Home facilities for public review for 3 years.
Page: 1 of 3

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

Inland Empire CC, 3737 Main Street Suite 700
Riverside, Ca, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 02/09/2007

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

Infant Indoor Activity Areas
Room #1: 43.4 x 19.7 = 854.98 sq ft
Total indoor activity space: 854.98 divided by 35 = 24 children
Infant Outdoor Activity Area: 39.10 x 34.10 + 49.9 x 8.9 = 1392.11 sq ft
Total outdoor activity space: 1392.11 sq. ft. divided by 75 = 18 children
Limiting factor for infant capacity is the licensee's request. Infant capacity is limited to 16
children.
School-Age Indoor Activity Areas
Room #5: 30 x 22.3 = 669 sq ft
Room #7: 17.5 x 20.4 = 357 sq ft
Total indoor activity space: 1026 divided by 35

= 29 children

School-age Bathroom Fixtures
2 toilets x 15 = 30 children
2 sinks x 15 = 30 children
School-Age Outdoor Activity Area: 61.2 x 62.7 = 3837.24 sq ft
Total outdoor activity space: 3837.24 sq. ft. divided by 75 = 51 children
Limiting factor for school-age capacity is the licensee's request. School-age capacity is limited to
24 children.
The "Isolation Room": 13.7 x 11.5 = 157.55 sq ft
Unocupied Room Croom #111: 11.1 x 11.8 = 130.98 sq ft
(CONTINUED )

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 320-7464

LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2007

I acknowledge receipt of this form and understand my appeal rights as explained and received.

DATE: 02109/2007

LIC809 (FAS) • (06/04)

Page: 2 of 3

 STATE OF CALIFORNIA ·HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cant)

Inland Empire CC, 3737 Main Street Suite 700

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL

Riverside, Ca, CA 92501

FACILITY NUMBER: 364818120
VISIT DATE: 02/09/2007

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During the POC visit on 02/09/07, LPA Douglas and LPA Garcia observed that all of the needed
corrections indicated by LPA Douglas during the initial pre-licensing visit have been successfully
completed at this time.
Please refer to LICB09 and 809C's dated 02/05107 for the list of those corrections needed.

The application will now be submitted for approval with a maximum capacity of 40 preschoolers, 16
infants, and 24 school-age children. 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: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782·4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 320-7464

LICENSING EVALUATOR SIGNATURE:

~i:~u4r

DATE: 02/09/2007

I acknowledge receipt of this form and understand my appeal rights as explained and received.

DATE: 02/09/2007

LIC809 (FAS) • (06/04)

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 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT

Inland Empire CC, 3737 Main Street Suite 700
Riverside, Ca, CA 92501

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL
ADMINISTRATOR:SENEWIRATNE, ROHITH
N. LITTLE MOUNTAIN DRIVE
ADDRESS:
CITY:
SAN BERNARDINO
40
CAPACITY:
TYPE OF VISIT:
Prelicensing
MET WITH:
Rohith Senewiratne

STATE:CA
CENSUS: 0

UNANNOUNCED

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATE:
TIME BEGAN:
TIME COMPLETED:

364818120
850
(909) 319-4884
92406
02/05/2007
09:00AM
02:45PM

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Licensing Program Analyst (LPA), Dennis Douglas, toured the proposed combination center,
inside and out. The days and hours of operation will be: 6:30am to 6:00pm. At the time of
visit, LPA Douglas observed that the licensee was stili in the preparation stage of getting the
facility in compliance with Title 22 Regulations. There were still a great deal of corrections
and repairs that needed to be made to the building and grounds. Following a breif
consultation with LPA Douglas during the visit, the licensee also expressed interest in
submitting a modified facility sketch to switch the functions of several rooms. LPA Douglas
decided not to take measurements of the indoor and outdoor activity space at this time. A
return visit shall be made prior to licensure of the facility.
During the pre-licensing visit on 02/05/07, the following was observed by LPA Douglas:
• Most of the classrooms were not adequately equipped with age and size appropriate furniture and
equipment
• Fountain water was the primary source for drinking water in the indoor activity space. However,
the fountains in several of the classrooms were not operable.
• The Playgrounds were enclosed by appropriate fences.
• The Outdoor activity areas were supplied with age and size appropriate equipment
• Adequate cushioning material was not placed under the play equipment
• Adequate shade was provided
• Drinking water was provided in the preschoolers outdoor play area by a drinking fountain,
however, outdoor drinking water was not provided for the school-agers and infants.
• Per the licensee, food will be provided by parents, and facility will have an adequate amount of
food supplies for snacks
• The office area is located near the main entrance of the building, and is located next to the
"isolation room".

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 320-7464

LICENSING EVALUATOR SIGNATURE:

~~....c-~ ~~---. . . . . . . .

DATE: 02/05/2007

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

<:~

DATE: 02/05/2007

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

Inland Empire CC, 3737 Main Street Suite 700

FACILITY NAME: LITTLE MOUNTAIN PRESCHOOL

Riverside, Ca, CA 92501

FACILITY NUMBER: 364818120
VISIT DATE: 02/05/2007

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Prior to licensure the following areas/documents must be corrected:
INFANT PROGRAM (classroom #1)
• Feeding chairs are needed
• A changing mat needed (for the changing table)
• Changing supplies are needed
• Drinking water is needed
• Classroom #1 needs to be furnished with more age appropriate furniture and equipment.
• Drinking water needs to be supplied in the infants outdoor activity area.
• The storage unit for the water regulator (located in the infants outdoor play area) must
be made inaccessible to the children.
• The entire outdoor play area needs to be cleaned, and free of all hazardous items.

PRESCHOOL PROGRAM (classrooms #2,3,4,6,8,9,1 0)
• Classroom #3 needs to be furnishied with more age appropriate furniture and
equipment.
• Classroom #3 needs indoor water supply (the water fountain currently in the classroom
is inoperable).
• Classroom #4 needs to be furnished with more age appropriate furniture and equipment.
• Classroom #6 needs to be furnished with more age appropriate furniture and equipment.
• The water pressure for the water fountain in Classroom #6 needs to be adjusted.
• Since Classroom #9 is not equipped with a toilet or sink, the licensee stated that a
portion of the wall separating Classroom #8 from Classroom #9 will be removed to form
one big classroom. (Classroom #8 is equipped with 1 toilet, 1 urinal, and 1 sink).
• The combination classroom (room 8 and room 9) will still need drinking water supplied
in the classroom (the water fountain currently in classroom #8 is inoperable).
(CONTINUED)

SUPERVISOR'S NAME: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 320-7464

gUu{j !'f

LICENSING EVALUATOR SIGNATURE:
.I

~

.......
, ...... _ _

DATE: 02/05/2007

I acknowledge receipt of this form and understand my appeal rights as explained and received.

DATE: 02/05/2007

LIC809 (FAS)· (06/04)

Page: 3 of 4

 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont)

Inland Empire cc, 3737 Main Stre&t Suite 700
Riverside, Ca, CA 92501

FACILITY NAME: UTILE MOUNTAIN PRESCHOOL

FACILITY NUMBER: 364818120
VISIT DATE: 02/05/2007

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• The combination classroom will also need to be furnished with more age appropriate
furniture and equipment.
• Classroom #1 0 ("The Activity Room") also needs more age appropriate furniture and
equipment.
• The outdoor play area needs to separated from the school-agers outdoor play area.
• The play structures need to have adequate cushioning material.
• The entire outdoor play area needs to be cleaned and free of hazardous items.

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SCHOOL-AGE PROGRAM (classrooms #5 and 7)
• Classroom #5 needs to be furnished with more age appropriate furniture and equipment
• Classroom #7 (The "Activity Room") (connected to classroom #5) also needs to be
furnished with more age appropriate furniture and equipment.
• Per the licensee, the walk-in closet inside classroom #7 will serve as a "pantry" to store
snacks.
• The girls and boys bathrooms (located just outside Classroom #7) needs to be cleaned.
•
•
•
e

The outdoor play area needs to separated from the preschoolers outdoor play area.
The play structures need to have adequate cushioning material.
Outdoor drinking water needs to be supplied.
The entire outdoor play area needs to be cleaned and free of hazardous items.

Once all corrections have been made, a second visit will be made to the facility to observe those
corrections. If the corrections are sufficient, the application will then be submitted for approval with a
maximum capacity of 40 preschoolers, 16 infants, and 24 school-age children. As agreed upon by
the applicant, all corrections listed are due within 30 days. If not received within 30 days from the
date of this report, the application will be denied. 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: Tammy J. McMichael-Peirce

TELEPHONE: (951) 782-4970

LICENSING EVALUATOR NAME: Dennis Douglas

TELEPHONE: (951) 320-7464

LICENSING EVALUATOR SIGNATURE:

~~~7

DATE: 02/05/2007

...............

I acknowledge receipt of this form and understand my appeal rights as explained and received.

DATE: 02/05/2007

LIC809 {FAS) • (06104)

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