191503710-8-16-2023-33-CC-JHUA-CURUA3-20230816152404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191503710
Report Date: 08/16/2023
Date Signed: 08/16/2023 03:24:10 PM

Document Has Been Signed on 08/16/2023 03:24 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 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: 56	DATE:	08/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:56 AM
MET WITH:	Georgette Delgado		TIME COMPLETED:	01:50 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 Analyst (LPA) Jennifer Hua conducted an unannounced Required - 1 year inspection. Upon arrival, LPA met with Georgette Delgado, director. A COVID-19 risk assessment was conducted prior to entry to the facility. LPA provided director with a copy of the LIC 125 Entrance Checklist to facilitate the inspection. This is a preschool program. Facility also has a licensed Infant Program #198020075. Business hours are from Monday-Friday, 6:30 AM to 6:00 PM. LPA was guided to a facility tour by director at 12:04pm. All areas identified on the Facility Sketch were inspected. There are of total of 3 classrooms. LPA observed the following: Room #1, 21 children with 2 staff, Room #2, 22 children with 2 staff, Room#3, 13 children with 2 staff. The facility was observed to be within the license capacity and limitations. Children's roster was reviewed. Sign-In and Sign-Out sheets were reviewed. 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. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed. A first aid kit is kept in each classroom. Carbon monoxide detectors and smoke detectors are present in the facility. Fire extinguishers are serviced annually. Storage cabinet in classrooms was locked and hazardous items including cleaning compounds were stored inaccessible to children.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MT. CALVARY LUTHERAN PRESCHOOL & DAY CARE CENTER	FACILITY NUMBER: 191503710
	VISIT DATE: 08/16/2023

NARRATIVE

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Children bring their own lunch, the lunch bags are stored in their cubby or parents can order online through Southland Catering lunch program. Morning and afternoon Snacks are offered, children also have an access to water fountain and also carry their own water bottles which were observed to be placed on table or in their cubby.

Outdoor equipment was inspected for safety, cushioning material, good repair and appropriateness. Required shade, drinking water and fencing were inspected. The children have access to drinking water during outside play was observed on site. Play area was inspected for hazards and inaccessibility to bodies of water. There is no bodies of water on site. Director and staff are current in Pediatric CPR and First Aid are on file for most staff & Director. Certificate are issued by the American Heart Assocation.

Teacher child ratios were observed, and staff names recorded. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate.

Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults for required transfers and associations. Staff have met the Immunization requirements.

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

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

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: 08/16/2023

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Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed and observed. 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 his/her responsibility to know the regulations as well as anyone who assists in providing care. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA advised that all staff 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.

Per director, isolation area in the director's office.

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.

No deficiency cited. An exit interview conducted with director. Notice of Site Visit form provided and shall be posted in an area accessible for review. Licensee rights provided.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

LIC809 (FAS) - (06/04)

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