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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597634
Report Date: 01/23/2023
Date Signed: 01/23/2023 05:27:43 PM


Document Has Been Signed on 01/23/2023 05:27 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:HOPE LUTHERAN PRESCHOOLFACILITY NUMBER:
191597634
ADMINISTRATOR:HEAD, ELLENFACILITY TYPE:
850
ADDRESS:1041 E. FOOTHILL BLVD.TELEPHONE:
(626) 335-5315
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:48CENSUS: 18DATE:
01/23/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Ellen HeadTIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cynthia Reyes, conducted an unannounced Case Management - Deficiencies inspection on this date. LPA met with Ellen Head, Director and LPA was taken on a tour of the facility.

During file review of staff files, it was determined by LPA Reyes, that four (4) staff have no proof of fingerprint clearance or proof of fingerprint associations. LPA asked Director for proof and Director Ellen Head stated she does not have any proof to provide on this date for the four staff.

LPA will conduct an annual inspection and other citations observed on this date will be cited at that time as time has permitted to complete the citations. LPA went over the citations with Director Ellen Head.

The following are being cited in accordance to Title 22 of the California Code of Regulations. Please refer to 809D for cited deficiencies.

LPA Reyes informed Administrator Ellen Head that this report dated 01/23/2023 documents a Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Director was also informed, that she needs to provide a copy of this licensing report dated 1/23/2023, that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with Administrator Ellen Head.

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
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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Document Has Been Signed on 01/23/2023 05:27 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: HOPE LUTHERAN PRESCHOOL
FACILITY NUMBER: 191597634

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/23/2023
Section Cited

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility. Obtain a California clearance or a criminal record exemption as required by the Department or request a
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Director states will have the four staff members get livescan or associated immediately and those staff members will not return to the facility until clearance is received and approved. Director states will update the department with who has been cleared and when. A $2,000.00 civil penalty is assessed.
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transfer of a criminal record clearance. This requirement is not met as evidenced by: Based on record review, the director did not comply with the section cited above. LPA observed staff # 2,3,4 and 6 are not fingerprint cleared or associated to the facility. This poses an immediate health, safety or personal rights risk to persons in care.
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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
LIC809 (FAS) - (06/04)
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