28-CICT -2014 20: 01

FRCII1:

TCI:15108496141

STA'ri:J: OF CALIFORNIA· HEALTH AND HUMAN 81!1'1:\f\CES AGI!~CY

CAI.IFORNIA DllPARTMI!NT QP SO(;IAL. ei!R:VICe!l
COMMUNITY C:ARi UO!,.SING Dl\n910N

FACILITY EVALUATION REPORT

FACILitY NAME: SIERRA SCHOOL
ADMINISTRATOR: HERATH. LALANIE
ADDRESS:
18045-47 SIERRA HIGHWAY
CITY:
CANYON COUNTRY
CAPACITY:
85
TYPE OF VISIT: Annual/Required
MET WITH:
Lalanie Herath

CCI..O R*QIOnal r::tm~•. 8117 6AJSTOL PAHKWA.V 1400
CUI.Y~R CrN, CA tot:IO

STATE:CA
CENSUS: 29
UNANNOUNCED

FACILITY NUMBER:
FACILITY TYPE:
TELEPHONE:
ZIP CODE:
DATe:
TIME BEGAN:
TIME COMPLETED;

197403707
850
(661) 252-6422
91351
10/1712014
02:30PM
04:42PM

NARRAtiVE
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Licensing Program Analyst (LPA) Linda Thompson-Miller met with the Director, LaLanie
Herath who guided analyst on a tour of the facility for an Annual Required visit. LPA
toured and inspected the preschool in accordance with the facility sketch. LPA observed
29 children upon arrival (there were 3 Teachers and no aides along with the director). The
facility consists of 3 classrooms. The facility operates from 6:00 am to 6:00 pm. Children
napping upon arrival.
Furniture and equipment were inspected for age appropriateness and good repair, All
rooms are clean and safe. Telephone service was verified in each room. Heating,
lighting, and ventilation are adequate, There are cubbies (each room) for children's
belongings. LPA observed age appropriate toys and materials. Drinking water is
available inside the classrooms (water fountain) and personal bottles. LPA observed a
sufficient quantity of cots available for napping children. The bedding is stored separately
and properly Inside the cubbies.
LPA inspected and observed 3 clean bathrooms (5 sinks, 6 toilets). Toilets and sinks are
functioning properly and are age appropriate. LPA observed soap, toilet paper and paper
towels readily available. Water temperature was tested and is appropriate. There is also a
Staff bathroom (Room #3).
Outdoor play equipment was inspected for health. safety, cushioning material, good repair
and a e appro riateness. Lar e pia e uipment and structures are secure! anchored.
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LICENSING EVALUATOR NAME: Linda Thompson-Miller

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TELEiPHONE: (310) 337-4349

LICENSING eVALUATOR SIGNATURE:
DATE: 10/1712014
I acknowledge receipt of this form and understand my licensing appeal rights as e><plalnod and rec:oived.
FACILITY REPRESENtATIVE SIGNATURE:

LJ.ll

l~

DATE: 10/17/2014

thi& rtport rnust be available at Child Care and Group Home facilities for public review for 3 yeare.
LIC80t(FAIIJ '(001..1

P~oe:

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 28-0CT-2014 20:01

FRml:

T0:15108496141

CAUFQRNIA D!PARTII!N'f QP SOCIAl. URVICI!ll
c;DMMUNITV OARS: UIO':INitNQ OMtuON
OC!l.D R_,j~•l OfftM. itltlllo7 BRIBTQI.. PMKWAV !MOO
Clll.VIR CITVI CA rt023Q

FACILITY EVALUATION REPORT

197403707

FACIUTY NUMBER:
FACILITY TYPE:

FACILITY IIIAME: SIERRA SCHOOL
ADMIIIIISTAATOR~HI"RATH, LA LANIE
ADDRESS:
18045-47 SIERRA HIGHWAY
CITY:
CANYON COUNTRY
CAPACITY:
65
TYPE OF VISIT: Case Management
MET WITH:
LaLanle Heralh

STATE: CA
CENSUS: 22

UNANNOUNCED

TELEPHONE:
ZIP CODE:

660
(661) 252-6422

DATE:
TIME BEGAN:
TIME COMPLETED:

91351
09/06/2014
08:35AM
10:30AM

NARRATIVE
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Licensing Program Analyst (LPA) Thompson-Miller met with Director, Lalanie Herath for a
Case Management· Incident visit involving an Incident Report dated June 11, 2014. The
Incident occurred on May 1El, 2014.
...,
The focus of the visit Is to Interview children and obtain staff written Declaration.
Qascriotlon of the ior;;ident: Site was contacted by Detective regarding a report Incident
where a child said a Teacher hit her.
LPA interviewed children.
Child #1 no longer attends facility (parent terminated services on 5/23/14), LPA received
two statements from staff written on Declaration form. There Is not enough
preponderance of evidence that Child #1 was hit by Teacher.
An exit interview was conducted and a copy of this report was provided to the Director
Lalanie Herath on this date.

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TELEPHONE: (310) 337-4335

LICENSING EVALUATOR NAME: Linda Thompeon-Miller
LICENSING EVALUATOR SIGNATURE:
i,..:;l

DATE: 09/05/2014

I acknowledge n~..elpt of thla form and underttand my licensing appeal rights 111 explained and rtcolved.

'z::t_'"'•'";j:'"A
Thle report must be available •t Child Cart and Group
LICBlll (~All • (OIW<II

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Hom" facilities for public review for 3 yeara.

 28-0CT-2014 20:02

FROM:

T0:15108496141

STATE Of caUIKIIIIIl!A1 ANQ HUMAN SERV:ICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIPORNIA OEPARTl\III~N'T OF SOCIAl. setMCES
COMMUNITY CARl: l.IOEN&ING DIVISION
CCL.D R•glcmll otflc•, $18'7 BRISTOL. PARKWAY tMOU
OUI,VI!f:R CITY, CA. to'SO

This is an official report of an vnannounc&d visiVinveatigetion of o complaint received In our office on
03/26/2012 and condvoted by Evaluator Linda Thompson-Miller
COMPI.AINT CONTROL NUMBER: 30-CC-20120326170642
FACILITY NAME: SIERRA SCHOOL
ADMINISTRATOR: HERATH, LA LAN IE
ADDRESS:
18045·47 SIERRA HIGHWAY
CITY:
CANYON COUNTRY
CAPACITY:
85
MET WITH:

STATE:
CENSUS: 26
UNANNOUNCED

La Lanle Herath

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

197403707

650
(661) 252-6422
91351
04/25/2013

06:50AM
09:25AM

ALLEGATION($):
1 Physical Plant

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INVESTIGATION FINDINGS:
1 LPA Linde Thompson-Miller conducted an unannounced complaint visit for the pvrpose identifying the finding
2 for the above allegation. LPA met with La LMie Herath, Director.

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Evidence and interviews conducted did not support septic tank problern.
Based on the information gathered there was not enough evidence to support allegation. At this time the
complaint is rendered Inconclusive.

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9 A copy of this report was explained and issued to Director, La Lanie Herath.
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lnconclualve
SUPERVISOR'S NAME: Bill Mayeda

Estimated Days of Completion:
TELEPHONE: (310) 337..41341

LICENSING EVALUATOR NAME: Linda Thompson-Miller

TELEPHONE: (31 0) 337..41335

LICENSING EVALUATOR SIGNATURE:

l

DATE: 04/2512013

I acknowledge receipt of this form and undenatand my appeal rights ae explained and reoeived.
FACILITY REPRESENTATIVE SIGNATURE:

~I

OATE: 0412512013

This report must be available at Child Car'! and Group Home facllitie& for public review for 3 y11ars.
LIC909\l (FASI• (D8104)

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FROM:

T0:15108496141

GTATI! Ofl' CALIFORNIA • HiiALTH ANO HUMAN 1!1tVIC:E$ AQI!NeV

CAL.II'ORNIA D!PAA'r!WISNT Opt IIQCIAL I!U!ftVtcll:i
COM~UNITY CAAI! LICIINSING PM&ON

ADVISORY NOTES

CCLO ,_-u1011a1 O«<t:!•, 11l7 BRJSTOL li'ARKWAY MOO
CULV!R Crrv, CA to:l30

FOR:
DATE:

SIERRA SCHOOL
09/21/2012

197403707

The following notes are not kept in the public portion of tne facility file and are provided to you to assist
you in the maintenance and operation of your facility. This Is not 11 citation.
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LICENSING EVALUATOR SIGNATURE:

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LIC&102iFAliJ ·17/iltl

DATE; 091211201 2

 28-CICT -2014 20: 03

FRCII1:

TCI:15108496141

• HEALTH AND HUMAN SERVICI:S AGENCY

FACILITY EVALUATION REPORT (Cont)
FACILITY NAME: SIERRA SCHOOL

CALIFORNIA LlliiPAftTI/II;;~T OF SOCIAl. Sr:RVJCe6

COMMUNITY CARl! LICI,.SI)IIG OMSION
CCL.O 1\eQional Otnct, fi1fi71!lFIIeTOI. PARKWAY ..00
CULVI!!R CITY, CJI. ",1:30

FACILITY NUMBER: 197403707
VISIT DATE: 10/17/2014
NARRATIVE

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The area was observed to be free of debris. There is an area for shade and rest.
Drinking water is available in the form a water fountain. Play area was inspected for
hazards and inaccessibility to bodies of water. The play area behind rooms 1 & 2 was
inspected for safety. There are Little Tikes play equipment, tables and climbing equipment
that is age appropriate. There is a drinking fountain, shade and cushion for the play area.
The gate on the right and middle of the yard have a lock.
Children are inspected for illnesses as they arrive. A review of medication policy indicated
that prescription medication is administered only with parent and doctor written
permission. The Director administers the medication and documents the dosage, date
and time onto a log. Medication is brought and taken home by the parent daily,
Medication is properly labeled and stored in its original container in the First Aid cabinet in
the kitchen with lock. There is a separate area for isolation and care of ill children in the
Classroom #3 or the Director office. There is a cot available for each ill child. An isolated
toilet and sink are available for ill children (staff restroom).
There is a clean kitchen with refrigerator/freezer, stove and microwave oven. The facility
provides two snacks and parents provided lunch. Menus are posted in the office, kitchen
and each classroom. Allergy lists are posted in the kitchen area. LPA observed an
appropriate amount of food and snacks. The chemicals are kept separate (room behind
kitchen/Room #2) from the food.
Teacher child ratios were observed and staff names recorded, Care and supervision was
evaluated to determine if the basic needs of children are met and appropriate, Staff were
questioned to establish their familiarity of emergency reporting requirements, emergency
disaster plans and other site operations. Personal rights of children were discussed.
Trash cans have lid.
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LICENSING EVALUATOR NAME~ Linda Thompson-Miller

-4313

TELEPHONE: (310) 337-4349

LICENSING EVALUATOR SIGNATURE:

l. \

DATE: 1011712014

DATE: 1011712014

LICIOU IFA81·108104}

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FROM:

T0:15108496141

OTATI:i OF t;;ALI~ORNIA- HEALl'H AN (I HUMAN BEAIJ1CE8 A0~N¢V

CALiflORNIA OilPAM'MfSNT 0~ ~ClAI.,. fli!RVICI!8
COMMUNITY CARE! LICINISING DIVISION

FACILITY EVALUATION REPORT (Cont)

CCLO A!WII<ll\1111 Otnt::e,ll187 BFUSTOL, PARKWAY HOO

FACILITY NAME: SIERRA SCHOOL

CUl.VII!R CITY, Cit 10230

FACILITY NUMBER: 197403707
VISIT DATE: 10/1712014
NARRATIVE

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Sign in and out sheets were reviewed. The parent board was reviewed and has all of the
required forms posted. Earthquake and Fire Drills are conducted regularly and are
current
Children's records and staff records were reviewed. All staff are certified in Pediatric
CPR and First Aid expire 7/5/2015. LPA informed the director about the new AB633
legislature and explained the procedure. Additional forms and a copy of Title 22
Regulations may be obtained at the department's website www.ccld.ca.gov.
Licensee is advised to visit www.shotsforschool.org for lmmuni:~:ation information.
No deficiencies cited according to Title 22 Regulations.
Exit Interview conducted and a copy of report provided to Director.

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LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 10/1712014

I acknowledge receipt of this form and uoderetand my app$al rlghta ae nxplalnad and rl)t:elved.

F~PRES~ATURIS:
LIC800 !"All) •IIIMI4)

DATE: 10/1712014

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