191503710-1-22-2020-33-CC-JHUA-BL3R5X-20200122114352

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191503710
Report Date: 01/22/2020
Date Signed: 01/22/2020 11:43:56 AM

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:	MT. CALVARY LUTHERAN PRESCHOOL & DAY CARE CENTER		FACILITY NUMBER:	191503710
ADMINISTRATOR:	GEORGETTE DELGADO		FACILITY TYPE:	850
ADDRESS:	23300 EAST GOLDEN SPRINGS DR.		TELEPHONE:	(909) 861-2740
CITY:	DIAMOND BAR	STATE: CA	ZIP CODE:	91765
CAPACITY:	72	CENSUS: 32	DATE:	01/22/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Georgette Delgado		TIME COMPLETED:	10:30 AM

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	Annual inspection was conducted by Licensing Program Analyst, Jennifer Hua, who met with Director, Georgette Delgado, who guided analyst on a complete tour of the facility. There are 3 classrooms for the preschool program. There is a licensed infant program and a private school Kindergarten - 8th grade on the same premise. The facility operates M-F 6:30am - 6:00pm. Rooms identified on facility sketch were inspected Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Napping equipment and bedding were inspected. Storage for children's belongings and an isolation area with a sink, toilet, and mats/cots was inspected. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed. Outdoor area and equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness. A review of cleaning and food supply storage areas was made. Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met. Report continues to next page

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MT. CALVARY LUTHERAN PRESCHOOL & DAY CARE CENTER	FACILITY NUMBER: 191503710
	VISIT DATE: 01/22/2020

NARRATIVE

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Staff and children records were reviewed for completeness including but not limited to Criminal Record Clearances for adults, Director Qualifications and verification of CPR/First Aid and health preventive practices documentation. Review of required forms was made. All staff have completed the Mandated Reporter Training on department website at http://www.mandatedreporterca.com/ Certificates in files reviewed.

A review of all facility staff or other individuals who require caregiver background checks was conducted on this date to determine if they have received criminal record and child abuse index clearances or exemptions and/or have provided proof of submission of finger prints to DOJ, FBI and CAIC.

The facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation and Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.

After a complete inspection of the facility, No deficiency cited.

An exit interview was conducted, copy of report given.

Notice of Site Visit provided and explained. This notice must be posted for 30 days. A civil penalty of $100 will be assessed if removed prior to 30 days.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

LIC809 (FAS) - (06/04)

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