197402147-6-8-2022-30-CC-SORS-CF83DU-20220608181006

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197402147
Report Date: 06/08/2022
Date Signed: 06/08/2022 06:10:21 PM

Document Has Been Signed on 06/08/2022 06:10 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:	BETHLEHEM LUTHERAN PRESCHOOL		FACILITY NUMBER:	197402147
ADMINISTRATOR:	MARY ASHDJIAN		FACILITY TYPE:	830
ADDRESS:	12227 BALBOA BLVD.		TELEPHONE:	(818) 368-6947
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	30	CENSUS: 12	DATE:	06/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Mary Kandilian - Director		TIME COMPLETED:	06:15 PM

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On 06/08/2022 Licensing Program Analyst (LPA) Suzette Ornelas, conducted an unannounced Annual Required Inspection for the infant license. LPA met with Director, Mary Kandilian, and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday 7a-6p.

Center has licensed Preschool (191201596) and licensed School-age (197420035) on the premises.

LPA toured and inspected the facility in accordance with the facility sketch (programs are kept physically separate). A review of the sign in/out sheet was conducted to verify the current census of children. Parents sign children in and out via sign in sheet. Currently there is a total of 4 infants with 1 teacher present and 8 toddlers with 2 teacher. Teacher/child ratios are maintained, and adequate supervision is being provided during this visit.

There is no swimming pool or other bodies of water on the premises. LPA observed wading pools in the outdoor areas which were not currently in use. Per Director, teachers provide extra supervision during use and ensure they are emptied out after each use. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection.

A walk through of the classroom area was conducted. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. The infant indoor and outdoor activity space is physically separate from the space used by other day care children. 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. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

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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Document Has Been Signed on 06/08/2022 06:10 PM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BETHLEHEM LUTHERAN PRESCHOOL	FACILITY NUMBER: 197402147
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101170(d)

Criminal Record Clearance

(d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in 1 out of 3 staff did not have a criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/22/2022
	Plan of Correction
1 2 3 4	Per director, staff member was advised on the need to obtain the criminal record clearance. Staff member left the premises and informed director that the background clearance check was completed. DIrector will associate staff member once clearance is available via Guardian.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/08/2022 06:10 PM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BETHLEHEM LUTHERAN PRESCHOOL	FACILITY NUMBER: 197402147
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(C)

Responsibility for Providing Care and Supervision for Infants

(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in 11 out of 12 infants did not have an infant sleep log on file which poses/posed a potential health, safety or personal rights risk to persons in care.LPA observed an infant sleep log for one infant under 12 months.
	POC Due Date: 06/08/2022
	Plan of Correction
1 2 3 4	LPA informed director on 101429 Responsibility for Providing Care and Supervision for Infants regulation. Director immediately created an infant sleep log for 11 out of 12 infants which was implemented for all infants in care.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BETHLEHEM LUTHERAN PRESCHOOL	FACILITY NUMBER: 197402147
	VISIT DATE: 06/08/2022

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Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents. There is a working carbon monoxide detector.

Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have not 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. LPA conducted a file review and 1 out of 43 staff did not have a criminal record clearance.

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. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than four infants in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child, medical assessment, individual feeding plan, and Infant Needs and Services Plan. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Staff records contain documentation of meeting qualification requirements. Menus are posted at least one week in advance where an authorized representative can view them. Facility utilizes class dojo, a virtual service where parents can view the facility menu. The facility has sufficient age appropriate furniture, and equipment including cribs, cots or mats, changing tables and feeding chairs. There is indoor and outdoor activity space for infants that is physically separate. Each crib, mat or cot is occupied by only one infant at time and cribs are kept free from all loose articles including blankets and pillows and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. Staff physically checks on sleeping infants every fifteen minutes along with any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BETHLEHEM LUTHERAN PRESCHOOL	FACILITY NUMBER: 197402147
	VISIT DATE: 06/08/2022

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LPA observed an infant sleep log for one infant under 12 months. LPA informed director on 101429 Responsibility for Providing Care and Supervision for Infants regulation. Director immediately created an infant sleep log which was implemented for all infants in care. Documentation for infants up to 12 months includes sleeping position if it is other than on their back. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Staff-infant ratio requirements are being met while infants are sleeping.

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.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited:

Type B: 101429(a)(2)(C) Responsibility for Providing Care and Supervision for Infants and Type A: 101170(d) Criminal Record Clearance (see next page, 809 D) Licensee was provided a copy of their appeal rights.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

LIC809 (FAS) - (06/04)

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