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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191602005
Report Date: 12/05/2023
Date Signed: 12/05/2023 03:57:00 PM


Document Has Been Signed on 12/05/2023 03:57 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:LAKEWOOD VILLAGE COMMUNITY CHURCH NURSERY SCHOOLFACILITY NUMBER:
191602005
ADMINISTRATOR:MARIE TUSCANYFACILITY TYPE:
850
ADDRESS:4919 CENTRALIATELEPHONE:
(562) 421-4486
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:84CENSUS: 17DATE:
12/05/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Joanne LuybenTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required - 3 Year Inspection. LPA met with Director Joanne Luyben who assisted with a tour of the facility. This is a Preschool Program serving children two years nine months to five years old. The hours of operation are: Monday through Friday 9:00am to 2:00pm. The preschool program (indoors and outdoors) is physically separate from a Church housed on the premises.

All areas identified on the Facility Sketch were inspected. At approximately 1:20pm LPA observed the following: 18 students on the East outdoor playground with the Director and teacher. Note: Room 1, Room 2, Room 3, Room 4, Room 5, Room 6 were all empty during outdoor play. LPA inspected the classrooms, outdoor areas, furniture, and equipment for age appropriateness and good repair. Director Luyben indicated that the school may undergo minor construction projects in the future. LPA informed Director to contact Licensing approximately 30 days prior to construction to discuss the project and how it will affect operations.

LPA observed telephone service, heating, lighting and ventilation to be satisfactory. Children have adequate cubby storage for their belongings. There is no nap time as the facility operates a half day program. LPA observed drinking water dispensers 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 children's toilets and sinks are in operable condition. LPA reminded Director to store items such as hand sanitizer and cleaners in inaccessible areas or have items locked. Classrooms have surfaces that appear to be clean and safe and there are age appropriate toys and reading material for children to use. There are first aid supplies in each classroom. Note: Per Fire inspector B. R. (10/17/23) the facility is not required to have smoke detectors. Carbon monoxide detectors were tested and are in operable condition. LPA observed a fire extinguisher due for service in September 2024. Hazardous items including including medicine and cleaning compounds are stored in inaccessible areas such as locked offices and locked cabinets.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2023
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LAKEWOOD VILLAGE COMMUNITY CHURCH NURSERY SCHOOL
FACILITY NUMBER: 191602005
VISIT DATE: 12/05/2023
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storage spaces. The office is used as an isolation area for ill children and there are portable mats and chairs for rest if necessary. Parents are contacted immediately if children are ill. Director indicated there are no weapons or bodies of water at the facility and LPA did not observe any.

The facility indoors and outdoors are completely separate from Church that operates on the same premises. The outdoor play area is completely surrounded by gates that are less than five feet high (since 1994 inception). Areas around and under climbing equipment have cushioning material for a fall. All play equipment, toys, materials and surfaces accessible to children appear to be age appropriate and toxic free.



Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Snacks were reviewed for availability, quantity, expiration dates and appropriateness for children in care. The facility provides an AM and PM snack and parents provide lunch. LPA observed the snack storage areas near the classrooms appearing to be in sanitary condition. LPA informed Director to constantly assess expiration dates on food items and document dates. LPA observed drinking water available (indoors and outdoors) and trash receptacles have tight fitting covers. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are locked and/or inaccessible.

LPA observed sign in and sign out to ensure children are being properly signed in and signed out by the authorized representative. LPA conducted five 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. The children's roster was available and current.

Staff Records will be reviewed at a a later date for 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 October 2025) .

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: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LAKEWOOD VILLAGE COMMUNITY CHURCH NURSERY SCHOOL
FACILITY NUMBER: 191602005
VISIT DATE: 12/05/2023
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Mandatory forms for the children’s files and staff files, requirements for fire drills, earthquake drills (last October 2023) and documentation were discussed. 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. Staff has completing 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. http://www.ccld.ca.gov/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 Joanne Luyben 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: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC809 (FAS) - (06/04)
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