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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600684
Report Date: 10/27/2022
Date Signed: 10/27/2022 02:39:02 PM


Document Has Been Signed on 10/27/2022 02:39 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOLFACILITY NUMBER:
191600684
ADMINISTRATOR:NANCY J. DURKOVICFACILITY TYPE:
850
ADDRESS:1100 POINSETTIA AVE.TELEPHONE:
(310) 545-5653
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY:125CENSUS: 64DATE:
10/27/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:NANCY DURKOVICTIME COMPLETED:
02:55 PM
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On 10/27/2022, Licensing Program Analyst (LPA) Loyce Phillips, conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone on 9/14/2022. LPA met with Director, Nancy Durkovic and toured the facility and took a census of the children. Upon arrival, there were 64 children present today.

On 9/12/2022 1 child was diagnose with Hand, Mouth and Foot. On 9/13/2022 2 children were diagnose. On 10/17/2022 1 child diagnose. The children were in 2 separate classrooms (the red room and green room). All 4 children were kept home and returned to the facility with a doctors note. All parents from both classrooms were notified. Director contacted Department of Public Health and left a message.

Both classrooms that children were in have been clean, sanitize and disinfected by the maintenance staff. Hard touched surfaces, equipment, toys and linen were cleaned. The staff continues to do a overall daily health screen of children.

No Title 22 violations have occurred and no deficiencies cited. Director was encouraged to continue to report unusual incidents that occur in the facility in a timely manner.

An exit interview was conducted, a copy of this report and notice of site visit was provided to Director, Nancy Durkovic.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
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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