191501048-3-12-2024-54-CC-CKAM-D3AU79-20240312151935

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191501048
Report Date: 03/12/2024
Date Signed: 03/12/2024 03:20:04 PM

Document Has Been Signed on 03/12/2024 03:20 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	CONCORDIA LUTHERAN PRE-SCHOOL		FACILITY NUMBER:	191501048
ADMINISTRATOR:	SUSAN JENNINGS		FACILITY TYPE:	850
ADDRESS:	13633 183RD ST.		TELEPHONE:	(562) 926-7416
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	60	CENSUS: 8	DATE:	03/12/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Elizabeth Medina		TIME COMPLETED:	03:30 PM

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 Analysts (LPAs), Claudia Kam and Tiffanie Tran made an unannounced required visit at above licensed facility. At 1:30 PM, LPA met with Elizabeth Medina and was taken on a guided tour of both indoors and outdoors of the facility. LPAs observed proper care and supervision and ratio. All center staff that was present during today’s inspection had fingerprint clearance and are associated to the designated license number. Teacher-child ratios were observed, and staff names recorded. Care and supervision evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. Personal Rights of children were observed by LPAs at time of inspection. This is a Preschool facility that shares the site with a school age before and after program, facility #198018931, the hours of operation are 7:00 am – 6:30 pm Monday - Friday. Facility is currently licensed for a capacity of 60. At the initial start of the site visit, there is a total census of 8 children and a total census of 2 teachers present. There are currently 13 children enrolled. The facility is made up of 3 classrooms. Room 1 and 2 are shared: had 8 children and 2 staff, Room 7: is currently not in use at time of inspection. LPAs observed all posting requirements for operation on the posting board LIC 203A-License, LIC 610 A-Emergency Disaster Plan, LIC 9148-Earthquake Preparedness Check List, PUB 394-Notification of parent’s rights poster, LIC 613A- Personal Rights, PUB 269- Child Car Seat Law, Menus, and Activity Schedule. Children and staff records were reviewed. LPAs observed current CPR and First Aid Certification for all center staff. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. Children napping equipment met the requirement regulation at time of inspection. Children were observed napping at time of inspection. Storage for children's belongings, bathrooms facilities, and isolation areas were inspected. Page 1 of 4

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia Kam	TELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CONCORDIA LUTHERAN PRE-SCHOOL	FACILITY NUMBER: 191501048
	VISIT DATE: 03/12/2024

NARRATIVE

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Age-appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, and safety and sanitation. LPAs observed crafting supplies, toys and educational materials. LPAs observed red backpacks for first aid kept in each classroom.

Children drinking water was observed. Center was reviewed for lead compliance and center meets standards for lead. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Snack/lunch menus were reviewed at time of inspection. Facility provides lunch, and snacks. All food items prepared by the facility. Food and snack items are properly stored. Food preparation area was toured for safety, cleanliness, and proper storage.
Carbon monoxide detectors and smoke detectors are present in the facility. LPAs confirmed detectors at time of inspection and were determined in operable condition. Fire extinguishers were observed as serviced on 8/4/2023. Hazardous items including poisonous cleaning compounds were stored inaccessible area to children. A review of medication policy, including administering, labeling, storage, and records was discussed as there are currently no children in care that require medication. Fire & Earthquake drill observed conducted monthly with last drill conducted on 2/27/24 per observation.
At 2:00 PM, LPAs observed outdoor play area which consists of 3 playhouses, play area, and a large shade tree. Outdoor equipment was inspected for safety, cushioning material, good repair, and age appropriateness. Required shade and fencing were inspected. A metal fence divides the preschool play area from the after school, school age program. LPAs advised Director that the children need to be always within the direct care and visual supervision by the teachers. Per Director, the children have access to drinking water via a refill water fountain, water fountains in the classroom and water bottles brought to the center daily. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed at time of inspection.

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SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia Kam	TELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CONCORDIA LUTHERAN PRE-SCHOOL	FACILITY NUMBER: 191501048
	VISIT DATE: 03/12/2024

NARRATIVE

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LPAs reviewed with Elizabeth Medina the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. CPR card expires on 8/5/23 for Staff Member. Inspection of required forms made.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked, and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care.

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SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia Kam	TELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CONCORDIA LUTHERAN PRE-SCHOOL	FACILITY NUMBER: 191501048
	VISIT DATE: 03/12/2024

NARRATIVE

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LPAs advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVESCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.
The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised to visit www.shotsforschool.org for immunization information.

These forms may also be downloaded from our website: www.ccld.ca.gov
The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 3/12/24.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative.

On 3/12/24 at 3:30 PM, exit interview was conducted with Director, Elizabeth Medina. A copy of this report was given, and appeal rights were issued and discussed.
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia Kam	TELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC809 (FAS) - (06/04)

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