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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500272
Report Date: 06/06/2019
Date Signed: 06/06/2019 03:25:53 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: 12DATE:
06/06/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Cerise Wills, Lead Teacher TIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Carlos Gonzalez conducted a Plan of Correction inspection on this date. LPA met with Cerise Wills, Lead Teacher, who guided Analyst on a tour of the facility. Also present was Teacher, Elizabeth Ordonez. LPA observed a total of twelve (12) children in care at the time of inspection.

The purpose of the Plan of Correction inspection was to determine if the Facility corrected the following:
  • If the Facility conducted and documented a fire/or disaster drill.


LPA determined that Facility did conduct a fire and an earthquake drill on 05/24/19 per the documentation provided.

No deficiencies cited, Facility is in compliance with California Code of Regulations Title 22 requirements. Notice Site Visit must be posted for 30 days or will result in a $100.00 civil penalty.
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Exit interview conducted with Cerise Wills, Teacher, and a copy of this report was provided.
Report ends page 1 of 1
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
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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