191602272-8-9-2022-54-CC-MAYA-CH5PZN-20220809114548

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191602272
Report Date: 08/09/2022
Date Signed: 08/09/2022 11:46:14 AM

Document Has Been Signed on 08/09/2022 11:46 AM - 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:	ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE		FACILITY NUMBER:	191602272
ADMINISTRATOR:	VELIA GUERRA		FACILITY TYPE:	850
ADDRESS:	4645 WOODRUFF AVE		TELEPHONE:	(562) 421-8441
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90713
CAPACITY:	72	CENSUS: 5	DATE:	08/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Director, Velia Guerra		TIME COMPLETED:	12:00 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	On August 9, 2022 at 8:00 am, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Director, Velia Guerra. The purpose of the inspection was to conduct the Required 1 Year inspection at the facility. Entrance Checklist – Child Care Centers (LIC 125) was provided to the Director upon arrival. The facility is currently licensed for 72 children, ages 2 years until entry into first grade. The facility is located on St. Timothy Lutheran Church premises. There is also a licensed infant program with a toddler component located on site (License Number: 198005392). Per Director, the preschool program operates Monday through Friday from 6:30 am to 6:00 pm. The Director guided LPA on a tour of the inside and outside of the facility. All areas on the facility sketch were inspected. The facility has three (3) classrooms where care is provided. Upon arrival, the following staff were present: Staff (S1) with 5 preschool children in the outdoor play yard. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Napping equipment (cots) were observed in each classroom. Per Director, bedding is taken home weekly or as needed by parents or authorized representatives to be washed. Per Director, the isolation area is in the Director’s office. In the Director’s office, a cot can be placed on the floor for an ill child and the staff restroom is readily available if an ill child requires it. Age appropriate sinks, toilets and urinal were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed in each classroom. The facility did not have a carbon monoxide detector available at the time of the inspection. The facility has smoke detectors that were tested and are operable. The fire extinguishers are fully charged and were last serviced on November 5, 2021.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE	FACILITY NUMBER: 191602272
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.954

Licensure Requirements

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as the facility did not have a carbon monoxide detector available which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/09/2022
	Plan of Correction
1 2 3 4	The facility will install a carbon monoxide detector and the Director will submit proof of correction to LPA Ayala via e-mail by September 9th.

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as the facility did not have verification of disaster and fire drills available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/09/2022
	Plan of Correction
1 2 3 4	The facility will conduct a disaster and fire drill for the month of August, and the Director will submit verification of drills to LPA Ayala via e-mail by September 9th.

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE	FACILITY NUMBER: 191602272
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 personnel records which poses/posed a potential health, safety or personal rights risk to persons in care.The Director did not have on record immunization against measles and influenza, and Staff (S1) did not have on record immunization against measles and pertussis.
	POC Due Date: 09/09/2022
	Plan of Correction
1 2 3 4	Staff will obtain the required immunizations or immunization records, and the Director will submit copies of the records to LPA Ayala via e-mail by September 9th.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 personnel records (Director and S1) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/09/2022
	Plan of Correction
1 2 3 4	Staff will complete the required Mandated Reporter Training, and the Director will submit proof of completion to LPA Ayala via e-mail by September 9th.

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/09/2022 11:46 AM - 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE	FACILITY NUMBER: 191602272
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101215.1(m)

Child Care Center Director Qualifications and Duties

(m) A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as the Director did not have proof of completion for the required Preventative Health and Safety Practices (EMSA-approved) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/09/2022
	Plan of Correction
1 2 3 4	The Director will complete the Preventative Health and Safety Practices Training and submit proof of completion to LPA Ayala via e-mail by September 9th.

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 personnel records (Director and Staff (S1)) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/09/2022
	Plan of Correction
1 2 3 4	Per Director, all staff are scheduled to renew their Pediatric First Aid and CPR certifications (EMSA-approved) on August 25th at 8:30 am. The Director will submit proof of completion to LPA Ayala via e-mail by September 9th.

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE	FACILITY NUMBER: 191602272
	VISIT DATE: 08/09/2022

NARRATIVE

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Disinfectants, cleaning solutions, medication and other items that are hazardous to children, were made inaccessible to children in all areas. Director confirmed that there are no poisons stored at the facility. All kitchen, food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste have tight-fitting covers that are kept on and in good repair. LPA observed electrical outlet covers installed in all child care areas.

Outdoor playground equipment is in a safe condition, free of sharp, lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with sand that could absorb a fall. Per Director, the sand is inspected daily by staff prior to use. There is adequate shade in the outdoor play yard. Availability of outdoor drinking water was observed. No bodies of water were observed on the premises.

All individuals present have obtained a criminal record clearance or criminal record exemption. The Director and Staff (S1) present during this inspection did not have a current Pediatric First Aid and CPR certification (expired June 2022). Per Director, all staff are scheduled to renew their Pediatric First Aid and CPR certifications on August 25th at 8:30 am.

LPA conducted a record review of 5 children’s records and 2 personnel records for completeness. Based on the record reviews, 5 out of 5 children's records did not have the Consent for Emergency Medical Treatment (LIC 627). Based on the record review, the Director did not have proof of completion for the Mandated Reporter Training, Preventative Health and Safety Practices, and immunization against measles and influenza on record. Based on the record review, Staff (S1) did not have proof of completion for the Mandated Reporter Training, and immunization against measles and pertussis on record. The names of children and staff whose records were reviewed were documented.

Children's roster was reviewed and is current. Sign-in and sign-out sheets were reviewed; all children present were signed in. Based on record review, the facility did not have a disaster drill and fire drill readily available for review. Per Director, transportation is not provided by the facility.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE	FACILITY NUMBER: 191602272
	VISIT DATE: 08/09/2022

NARRATIVE

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The facility provides the preschool children with morning and afternoon snacks. Per Director, children bring their own lunch each day from home. The food menu for August 2022 was not posted for the children’s parents or authorized representatives to view. Menus for the past 30 days were not available for review. During the inspection, snacks were reviewed for availability and quantity.

First Aid supplies were observed and kept in each classroom. According to the Director, medication is only administered to a child when accompanied with a doctor's note and medication is stored in a cabinet located in the classroom.

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.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with the Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA advised the Director on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at: www.ccld.ca.gov.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE	FACILITY NUMBER: 191602272
	VISIT DATE: 08/09/2022

NARRATIVE

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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/process.

Deficiencies were cited in accordance with Title 22 regulations (refer to deficiency pages).

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Director, Velia Guerra. Appeal Rights were discussed, and a copy was provided to the Director.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/09/2022 11:46 AM - 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE	FACILITY NUMBER: 191602272
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101227(a)(6)

Food Services 101227(a)(6) Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above as the facility did not have the menu for August 2022 posted or the menus for the last 30 days available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/09/2022
	Plan of Correction
1 2 3 4	The facility will post the menu for August 2022, and the Director will submit a copy of the menu for July 2022 and August 2022 to LPA Ayala via e-mail by September 9th.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
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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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

LIC809 (FAS) - (06/04)

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