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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500272
Report Date: 05/22/2019
Date Signed: 05/22/2019 03:58:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GRACE LUTHERAN CHURCH PRESCHOOLFACILITY NUMBER:
191500272
ADMINISTRATOR:ARREGUIN, CHRISTYFACILITY TYPE:
850
ADDRESS:17880 E COVINA BLVDTELEPHONE:
(626) 967-5855
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY:22CENSUS: 13DATE:
05/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Christy Arreguin, Director TIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carlos Gonzalez conducted an unannounced Annual/Random inspection on this date. LPA met with Christy Arreguin, Director, who guided Analyst on a tour of the facility. This is a preschool program which consists of two (2) classrooms. There is also an infant program on site, which currently operates under facility license number #198018207. Per Director, days and hours of operation are Monday thru Friday, from 6:30 AM to 6:00 PM.

All areas identified on the Facility Sketch were inspected. LPA observed thirteen (13) children napping in Room 1. No children were observed Room 2.

Furniture and equipment were inspected for age appropriateness and good repair. Adequate lighting and ventilation were observed in each classroom. Napping equipment and bedding were inspected for good condition, appropriate storage and cleanliness. Children's sheets/blankets are taken home on a weekly basis (every Friday), to be washed. Children's belongings are stored in an outdoor storage locker cabinet. Age appropriate sinks and toilets were inspected for availability, good repair, toilet paper, area safety and sanitation. The isolation area is located in the choir room, next to the church. Per Director, a cot is brought over in the event a child needs to lay down and sleep and children will use the staff restroom.

Snack menu was reviewed. Snacks were reviewed for availability, quantity and appropriateness to children in care. The facility provides a morning and an afternoon snack. Per Director, children bring their own lunches. LPA observed children's individual drinking bottles and there is also a water dispenser in Room 1. Cleaning compounds were observed to be kept inside of a locked closet located between Rooms 1 and 2.
Report continues on next page 1 of 3
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GRACE LUTHERAN CHURCH PRESCHOOL
FACILITY NUMBER: 191500272
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2019
Section Cited
CCR
101174(d)
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Disaster and Mass Casualty Plan - Disaster drills shall be conducted at least every six months. This requirement is not being met as evidenced by: LPA determined at the time of inspection, that a Fire/or Disaster drill has not been conducted within the last 6 months. This is
a potential risk to the health/safety of
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Per Director, a fire/or disaster drill will be conducted within the time frame allotted. Director will submit proof to LPA by the POC due date.
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children in care.
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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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRACE LUTHERAN CHURCH PRESCHOOL
FACILITY NUMBER: 191500272
VISIT DATE: 05/22/2019
NARRATIVE
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LPA determined that Director and staff have completed the Mandated Reporter training requirement.

During the inspection, LPA determined that Staff #1, is not currently associated to the facility. However, LPA reviewed documentation provided by Director, which indicated that Staff #1 requested to be associated to the current facility and to the infant care program simultaneously. However, LPA obtained the necessary documents at the time of inspection, from the Director, to associate Staff #1 to the current facility.

Based on LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Christy Arreguin, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
Report ends page 3 of 3
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRACE LUTHERAN CHURCH PRESCHOOL
FACILITY NUMBER: 191500272
VISIT DATE: 05/22/2019
NARRATIVE
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There is an outdoor play area on the premises. Areas around and/or under climbing equipment have sand to absorb a fall. Outdoor play equipment was observed to be in good repair. There is outside shade for resting and the yard is fully fenced. Outdoor water is provided via two (2) drinking fountains.

Teacher child ratios were observed and staff names recorded. Sign in/out sheets and procedures were reviewed with Director. Staff and children records were reviewed for completeness and an inspection of required forms was made. A copy of the Confidential Name List (LIC 811) was provided to the licensee. No bodies of water were observed on the premises.



UPDATE: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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.

LPA advised the licensee how to access forms and regulations on line at: www.ccld.ca.gov.

LPA also advised Licensee on how to obtain the Department's Quarterly Updates via the following website address: www.childcareadvocatesprogram@dss.ca.gov



Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors, and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Effective January 1, 2018: Existing licensees must meet requirements by March 30, 2018. Preventive (OCAP) online training modules are free of cost and available at http://www.mandatedreporterca.com/.
Report continues on next page 2 of 3
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4