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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070211160
Report Date: 04/06/2023
Date Signed: 04/06/2023 07:11:38 PM


Document Has Been Signed on 04/06/2023 07:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:FIRST LUTHERAN CHRISTIAN PRESCHOOLFACILITY NUMBER:
070211160
ADMINISTRATOR:SMITH, JENIFACILITY TYPE:
850
ADDRESS:4006 CONCORD BOULEVARDTELEPHONE:
(925) 798-5330
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:60CENSUS: 32DATE:
04/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Jeni SmithTIME COMPLETED:
07:15 PM
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On 04/06/2023 at 4:00 PM, Licensing Program Analysts (LPA) Christina Watts conducted an unannounced Annual inspection at First Lutheran Preschool . Facility is located on the grounds of First Lutheran Church. LPA met with Director, Jeni Smith and explained the purpose of this inspection. During today's inspection, there were 32 children in care with 5 qualified teacher in the room. Director stated there are 65 children enrolled. All staff in the facility have Criminal Record Clearance. Facility's operating days and hours are Monday - Friday 6:30 AM - 6:00 PM.

The physical plant was inspected. LPA toured the premises.
Indoor space: 5 classrooms (Blue Birds, Flamingos, Owls, Hummingbirds and Eagles, restrooms, and pantry were inspected. During inspection, children were napping under the visual supervision of the teachers, and aides. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair. LPA observed a working Fire extinguisher, Smoke and Carbon Monoxide Detectors. Log shows that the last Fire Drill was conducted on March 2023. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles. Facility’s License, Parents’ Rights Poster PUB 393, Personal Rights, Activity Schedules, and Menus were observed to be posted.

Facility completed state required lead testing and submitted documentation to licensing. LPA reminded the Director facility is required to test facility for lead every 5 years.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: FIRST LUTHERAN CHRISTIAN PRESCHOOL
FACILITY NUMBER: 070211160
VISIT DATE: 04/06/2023
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*PAGE 2*

Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards. LPA observed playground areas for children with age appropriate toys and play structures. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. Shade is provided by way of covered areas. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.

File Review: Children sign in and out procedures and logs were reviewed. A sampling of Children and Staff files was taken for review. All files contained required documents. There was at least one Teacher with current certification in Pediatric CPR/First Aid present at the facility during inspection. Children's Roster and Personnel Report was reviewed, and a copy obtained.



On or before March 30, 2018 any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided:
https://www.mandatedreporterca.com/training/child-care-providers. All staff has current Mandated Reporter certificate in file.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.CON'T ON PAGE 2*
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: FIRST LUTHERAN CHRISTIAN PRESCHOOL
FACILITY NUMBER: 070211160
VISIT DATE: 04/06/2023
NARRATIVE
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*PAGE 3*

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/ction-process.

In the areas that were evaluated, no regulatory violations were observed

Exit interview conducted and report was reviewed with the Director Jeni Smith. A Notice of Site Visit was given and must remain posted for 30 consecutive days

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
LIC809 (FAS) - (06/04)
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