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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600943
Report Date: 07/13/2022
Date Signed: 07/13/2022 04:21:06 PM


Document Has Been Signed on 07/13/2022 04:21 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:BETHANY LUTHERAN CHURCH PRESCHOOLFACILITY NUMBER:
191600943
ADMINISTRATOR:TAMARA SIMPSONFACILITY TYPE:
850
ADDRESS:4644 CLARK AVETELEPHONE:
(562) 429-7335
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:81CENSUS: 33DATE:
07/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tamara SimpsonTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required - 1 Year Inspection. LPA met with Director Tamara Simpson who assisted analyst with a tour of the facility. This is an preschool program serving children ages two (2) through six years old. There is a physically separate Kindergarten through Eighth grade school operating on the premises. The facility operates Monday through Friday 7:00 AM to 5:30 PM.

All areas identified on the Facility Sketch were inspected. At approximately 1:20pm LPA observed the following: Room 1 (0 Teachers, 0 children); Room 2 (0 Teachers 0 children); Room 3 (1 Teachers, 5 children); Room 4 (1 Teacher, 12 children); Room 5 (1 Teacher, 10 children); Room 6 (1 teacher, 6 children); Room 7 (0 Teachers, 0 children). Between 1:20pm and 2:00pm LPA inspected classrooms, outdoor areas, furniture and equipment for good repair. LPA observed telephone service, heating, lighting and ventilation to be satisfactory. Children have adequate cubby storage for their belongings. Napping cots are stored appropriately with bedding removed. The facility also provides sheets and blankets that are laundered weekly. LPA observed drinking water with drinking cups readily available in the classrooms. Age appropriate restrooms, sinks and toilets were inspected for good repair, water temperature, toilet paper, safety and sanitation. All available toilets and sinks are in operable condition. LPA reminded Director to store items such as hand sanitizer and cleaners in inaccessible areas or use locks. The indoor classrooms have surfaces that appear to be clean and safe and there are age appropriate toys and reading material for children to use.

All materials and surfaces accessible to children are toxic free. Carbon monoxide detectors and smoke detectors are present in the facility. Hazardous items including including medicine and cleaning compounds are stored in inaccessible areas such as high cabinets and inaccessible office cabinets. The outdoor patio is is used as an isolation area for ill children and there are portable cots for rest if necessary. Parents are contacted immediately if children are ill. Director Tamara Simpson indicated there are no weapons or bodies of water at the facility and LPA did not observe any.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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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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: BETHANY LUTHERAN CHURCH PRESCHOOL
FACILITY NUMBER: 191600943
VISIT DATE: 07/13/2022
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At approximately 1:30pm LPA observed outdoor play equipment to be in good condition, free of sharp, loose or pointed parts. The outdoor activity space surfaces are maintained in safe condition and appears to be free of hazards. Areas around and/or under climbing equipment have pour and play cushioning material to absorb a fall. All materials and surfaces accessible to children appear to be toxic free. There is plenty of shade.

Hot and cold lunches are provided by an outside vendor. The facility has backup emergency snacks that were reviewed for are quantity, freshness dates , availability, and appropriateness for children in care. The parents provide AM and PM snacks and the facility has back emergency AM and PM snacks. The facility does not use the kitchen. LPA advised Director to make microwaves in the classroom more inaccessible. LPA observed menus (that were visibly posted one week in advance) placed where the child's authorized representative can review. LPA also observed drinking water available indoors and outdoors and trash receptacles that have tight fitting covers. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are locked and/or inaccessible. The facility has one or more functioning smoke detectors and carbon monoxide detectors that meet statutory requirements.

LPA observed sign in and sign sheets to ensure children are being properly signed in and signed out by the authorized representative. LPA conducted a Children's Records Review for completeness and to ensure children have proper forms such as Identification and Emergency forms, Immunization records, Health History, Personal Rights, Parents Rights etc.on file. Children's roster was reviewed and is current.

At approximately 2:15pm Staff Records were reviewed to ensure the following: Criminal record clearance or criminal record exemption, education credits, current CPR/First Aid and health preventative practices, proof of immunization against pertussis and measles and influenza and/or flu declination, Mandated Reporter training, LPA observed at least one staff member to have current CPR (Expiration August 2022) .

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

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
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: BETHANY LUTHERAN CHURCH PRESCHOOL
FACILITY NUMBER: 191600943
VISIT DATE: 07/13/2022
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LPA observed First Aid supplies in each classroom and all medications are stored in an containers in the classroom. Fire extinguishers (type 2A-10BC) must be serviced at least annually (LPA observed service due date May 2023) LPA informed Director Simpson that any construction or remodeling should be reported to the Department before it occurs.

Mandatory forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Last drill was conducted every month (last date June 2022). 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. LPA advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. All staff are current with their Mandated Reporter Training.



LPA advised Director that all adults 18 years of age and older providing Care & Supervision and having a continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to access forms, regulations and quarterly updates. Records for all children and staff must be maintained for three (3) years after separation from the facility. Report Unusual Incidents and/or injuries to the parent/guardian immediately and to Child Care Licensing within 24 hours and/or the next business day. Visit www.shotsforschool.org for immunization information. All care for children require supervision at all times. If away from the facility, staff must be with children at all times (especially when outdoors). There were no violations of Title 22 requirements at this time.

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 Exit interview was conducted with Director Tamara Simpson and a copy of Appeal Rights (LIC 9058) was discussed and provided
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC809 (FAS) - (06/04)
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