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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191502305
Report Date: 02/16/2023
Date Signed: 02/16/2023 02:51:07 PM


Document Has Been Signed on 02/16/2023 02:51 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:TRINITY LUTHERAN PRESCHOOL & DAY NURSERYFACILITY NUMBER:
191502305
ADMINISTRATOR:FRANCES COWARDFACILITY TYPE:
850
ADDRESS:11609 S. STUDEBAKER ROADTELEPHONE:
(562) 864-2319
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:64CENSUS: 20DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Debbie Torres TIME COMPLETED:
03:00 PM
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On 2/16/2023 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection. LPA met with Director Debbie Torres who guided analyst on a tour of the facility. This is a preschool program which consists of two classrooms. Facility operates from Monday through Friday 6:30AM to 6:00PM. The facility also operates a half day program from 8AM to 12PM. There were 20 children and three staff present when LPA arrived. All staff present have a valid criminal record clearance and are associated to the facility.

All areas identified on the facility sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. The facility has central air and heating. Children have their own cubby to store their belongings. Children are provided with cots for napping. Per Director, children bring their own bedding and it is taken home weekly to be cleaned. The isolation area is located in the office. Ill children use the staff restroom next to the office. There are two restrooms available for children to use. One restroom has three toilets and a trough style sink. The second restroom has four toilets and two sinks. Age appropriate sinks and toilets were inspected for availability and good repair in both restrooms. General sanitation was observed.

Availability of indoor drinking water was observed in classrooms via a water dispenser. Per Director, each child brings their own water bottle and it gets re-filled throughout the day if needed. Per Site Supervisor, Teachers assist children with the drinking water. The facility has not tested for lead contamination in water. Per Director, water is used at times for food preparation. This is a potential health and safety risk to children in care. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Disinfectants and cleaning solutions are stored in a cabinet in the kitchen. Per Site Supervisor, there are no poisons stored at the facility and medications would be stored in the Director's office. Per Director, none of the children enrolled require medication at the moment. There is an operable carbon monoxide detector and an operable smoke detector in the facility.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TRINITY LUTHERAN PRESCHOOL & DAY NURSERY
FACILITY NUMBER: 191502305
VISIT DATE: 02/16/2023
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The outdoor playground area was evaluated. All areas around or under high climbing equipment and similar equipment are cushioned with material that absorbs a fall. LPA observed exposed cloth material that is placed underneath the wood chips in various parts of the playground. Cloth material may cause a tripping hazard for children in care. This is a potential safety risk for children in care. There is adequate shade in the play yard. Availability of outdoor drinking water was observed via a water dispenser. Per Director there are no firearms stored on the premises. There are no pools or bodies of water at the facility. The 2A10BC fire extinguisher was last serviced in February 2023.
Children’s Records were reviewed for completeness. 1 out of 10 children's records reviewed did not contain a signed LIC 995 Notification of Parent's rights.
LPA also reviewed staff records. Staff have completed First Aid/ Child infant CPR certification issued by the American Heart Association. Certification for all staff present expires in September 2023. LPA advised Director that certification must state pediatric first aid. Per Director, course was taken in conjunction with the elementary school on campus and a section for pediatric first aid/CPR was included for the preschool staff. LPA advised to have cards revised or take a course that will provide a correctly labeled card.
Staff present did have proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present did have proof against TB, measles, pertussis, and influenza. Director, Staff 3 and Staff 4 completed mandated reporter training for child care providers on 4/24/22. Staff 2 completed mandated reporter training for child care providers on 4/26/22. Director was advised to renew training every two years.
Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Two out of 20 children in care were not signed in. Disaster drill log was available, last drill was conducted on 12/06/2022. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. Menus are posted at least one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. LPA inspected the food preparation area. The facility provides two snacks and children have the choice of bringing lunch from home or using the outside food vendor. LPA observed children's lunch containers labeled with their names. First Aid supplies were observed in the facility, accessible to staff.
Site Supervisor 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.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 9
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TRINITY LUTHERAN PRESCHOOL & DAY NURSERY
FACILITY NUMBER: 191502305
VISIT DATE: 02/16/2023
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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

LPA informed Director of the importance of checking for recalled devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.



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/tion-process.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
The deficiencies listed on the following page were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. One type B is issued regarding the incompliance with the lead testing for water and one type B is issued regarding the exposed material in the playground. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Director Debbie Torres. Director was provided a copy of the report and appeal rights (LIC 9058).
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 02/16/2023 02:51 PM - It Cannot Be Edited

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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: TRINITY LUTHERAN PRESCHOOL & DAY NURSERY
FACILITY NUMBER: 191502305

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(1)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed exposed cloth material underneath the wood chips in 6 places in the playground which could be a tripping hazard which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2023
Plan of Correction
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Per Director, exposed material will be cut off and wood chips will be replenished. Per Director, exposed material will be cut off by POC due date. Wood Chips will be replenished at a later date. Per Director staff will be advised to remind children to play with caution in those areas in the mean time. POC will be provided via video.
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. Per Director, facility occassionaly uses water for food preparation but facility has not been tested for lead contamination which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2023
Plan of Correction
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Per Director, lead testing will be scheduled by POC due date. Director will provide proof to LPA via email.
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: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
LIC809 (FAS) - (06/04)
Page: 4 of 9