191607436-9-8-2022-30-CC-AALA-CJ3UM7-20220908154152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191607436
Report Date: 09/08/2022
Date Signed: 09/08/2022 03:42:01 PM

Document Has Been Signed on 09/08/2022 03:42 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	CALVARY CHURCH OF PACIFIC PALISADES		FACILITY NUMBER:	191607436
ADMINISTRATOR:	ERIN AHDERS		FACILITY TYPE:	850
ADDRESS:	701 PALISADES DRIVE		TELEPHONE:	(310) 454-6537
CITY:	PACIFIC PALISADES	STATE: CA	ZIP CODE:	90272
CAPACITY:	30	CENSUS: 0	DATE:	09/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 AM
MET WITH:	Director Brittany Gleason		TIME COMPLETED:	03:30 PM

NARRATIVE

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On 09/08/22 at 9:10 AM, Licensing Program Analyst (LPA) Antonio Almanza, conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Director Brittany Gleason and toured the facility indoors and outdoors. Days and hours of operation are Monday – Thursday 8:30 AM – 11:30 PM. Facility phone number is 310-573-0082. LPA conducted Risk Assessment prior to conducting site visit. During today’s visit there are no children no children care. Facility will resume operations on 09/12/22.

The facility has 2 Co-Op classrooms located on the first floor of the facility (Classrooms 145 and 148). The preschool is located on the premises of the Calvary Christian School grades TK - 8th grade. There is a security guard at the gate. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible to children in care. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. There are Phones, First Aid kits, Fire Pull-Down alarms and Hard-wired Fire Alarm systems in the classrooms. Fire Extinguishers (serviced on 12/20/2021) are located in the hallways of the facility.

Facility does not provide meals to children in care. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors.

The playground is located in front of the classrooms located on the second floor. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents. Pg 1

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CALVARY CHURCH OF PACIFIC PALISADES	FACILITY NUMBER: 191607436
	VISIT DATE: 09/08/2022

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Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The name of the child care center director or fully qualified teacher(s) designated to act in the director’s absence has been reported to the Department. LPA notified Director that children’s files shall include: LIC 613 A Personal Right, LIC 700 Identification and Emergency Information, LIC 701 Physicians Report, LIC 995 Notification of Parents’ Rights, LIC 627 Consent form. LPA notified Director that staff files shall include: health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. LPA observed all required postings in a prominent, public assessable area of the facility: Facility License, PUB 269 Child Passenger Restraint system poster, PUB 393 Notification of Parents Rights, LIC613A Personal Rights, and LIC610 Emergency Disaster Plan.

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.

Facility representative 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. Pg 2

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CALVARY CHURCH OF PACIFIC PALISADES	FACILITY NUMBER: 191607436
	VISIT DATE: 09/08/2022

NARRATIVE

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Incidental Medical Services (IMS) are currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Brittany Gleason.

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SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

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