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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414470
Report Date: 03/14/2022
Date Signed: 03/14/2022 01:24:54 PM


Document Has Been Signed on 03/14/2022 01:24 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:SHEPHERD OF THE VALLEY LUTHERAN CHURCHFACILITY NUMBER:
197414470
ADMINISTRATOR:CLAUDIA ZAVALA-LANZFACILITY TYPE:
850
ADDRESS:23838 KITTRIDGE STREETTELEPHONE:
(818) 348-8343
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:80CENSUS: 36DATE:
03/14/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Suzanne LegumTIME COMPLETED:
01:45 PM
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On 03/14/2021, Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced Case Management – COVID-19 inspection to follow up on a Covid19 Outbreak. Upon arrival, LPA met with Suzanne Legum (Director). LPA conducted a risk assessment and toured the inside and outside of the facility. LPA observed 36 children and 6 staff.

According to the Unusual Incident Reports LIC 624, on DATE 01/14/2022 - 12 children and 2 staff tested positive for COVID-19. The facility closed on 1/18/2022 and reopened on 01/24/2022.

Director stated that all children who tested positive for COVID-19 isolated and were cleared to return to the facility. See LIC 812 COVID-19 Follow Up for additional information about the positive COVID-19 cases.



Director stated during arrival at the facility children and staff must complete temperature checks every morning before entering the facility. Facility requires children and staff to wear masks during indoor settings
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHEPHERD OF THE VALLEY LUTHERAN CHURCH
FACILITY NUMBER: 197414470
VISIT DATE: 03/14/2022
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During the visit, LPA observed all staff and children wearing mask during indoor settings. LPA observed COVID-19 related signs/posters throughout the facility. Each classroom has, wipes, hand sanitizer, tissue. LPA observed all bathrooms fully stocked with soap and paper towels. LPA observed that school has an adequate amount of cleaning supplies. Director stated facility has a maintenance crew that cleans and disinfects the facility daily.

During the visit LPA and Licensee discussed the following best practices:

Face masks are no longer required but highly recommended

Isolation area - Isolation area is located in the director office or in an empty office. A designated staff will stay with the child until the parent arrives. The facility has an isolation restroom for children with symptoms.



Reporting Requirements – LPA explained and reminded Licensee to report all COVID-19 positives cases to Department of Public Health. In addition, report all positives cases and closure of facility or classrooms to Community Care Licensing. When reporting Unusual Incidents, call CCLD within 24 hours and submit Unusual Incident Report within 7 days.

No deficiencies are cited, per Title 22, Division 12, Chapter 3, of the California Code of Regulations.

An exit interview was conducted and a copy of this report (LIC 809) and Notice of Site Visit were provided to Director.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
LIC809 (FAS) - (06/04)
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