197414470-12-21-2023-58-CC-LSTN-CYQUDQ-20231221142956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414470
Report Date: 12/21/2023
Date Signed: 12/21/2023 02:31:04 PM

Document Has Been Signed on 12/21/2023 02:31 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	SHEPHERD OF THE VALLEY LUTHERAN CHURCH		FACILITY NUMBER:	197414470
ADMINISTRATOR:	SUZANNE LEGUM		FACILITY TYPE:	850
ADDRESS:	23838 KITTRIDGE STREET		TELEPHONE:	(818) 348-8343
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	80	CENSUS: 20	DATE:	12/21/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Suzanne Legum (Director)		TIME COMPLETED:	02:45 PM

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Licensing Program Analysts (LPA) Laticia Thompson, Jillinda Chandler and Doris Whitmore conducted an announced case management licensee-initiated inspection for the purpose of a capacity increase. The applicant is requesting to add a Toddler option with a capacity of 24 children ages 18-36 months to the existing Preschool. The following rooms will be added to the Preschool Toddler Option, Room #1 and Room#2. The hours of operation are Monday -Friday 8am-5pm.There is an approved fire clearance conducted on 05/18/2023 by Inspector Cindy Struck of the LA City Fire Prevention Bureau. The facility shares common grounds with an existing School Age Program (Kids Club #197493784). LPA met with Suzanne Legum who assisted LPA’s with touring the facility. Upon arrival there were 20 preschool children present.

Indoor Activity Space measurements:

The Indoor total measurements contain a total of 1483.13 square feet, which will accommodate Applicant’s requested capacity of 24.

Outdoor Activity Space Measurements:

Toddler Outdoor total measurements contain a total of 3193.33 square feet, which will accommodate Applicant’s requested capacity.

Preschool Outdoor total measurements contain a total of 5714.44 square feet, which accommodates licensee current capacity.

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SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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

FACILITY NAME: SHEPHERD OF THE VALLEY LUTHERAN CHURCH	FACILITY NUMBER: 197414470
	VISIT DATE: 12/21/2023

NARRATIVE

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Toddler option restroom has 2 sinks and 2 toilets. Toddler classroom #1 and classroom #2 has a total of 2 portable sinks in each room. There is a total of 6 sinks and 2 toilets. The hand washing fixtures located in the restrooms do not dispense hot water. The portable sinks dispense warm water to the touch.

The following was observed.

Staff restrooms are located in the office area near the entrance of the facility.

Parents will enter and exit through the front glass double door area located on Kittridge Street that leads into the front office.

Parents will sign in and out electronically under the Smart Care application. For best practice purposes, LPA advised facility there should be a plan in place on how the records would be backed up, and how they would be made available in the event of a power failure or disaster.

The facility provides filtered Brita water for outdoor and indoor activities.

There are operable combination smoke/carbon monoxide detectors in classroom #1 and classroom#2.

There is one portable changing table in each classroom.

LPA observed First aid kits with the required materials including a handheld digital thermometer.

Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts.

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SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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

FACILITY NAME: SHEPHERD OF THE VALLEY LUTHERAN CHURCH	FACILITY NUMBER: 197414470
	VISIT DATE: 12/21/2023

NARRATIVE

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Tables and chairs were observed to meet the needs of the children. There are cots for napping.

All play equipment and materials used by children were observed to be age-appropriate.

There are cubies in all classrooms for storage of children clothing and personal belongings.

There is a refrigerator located in classroom#1 that requires a thermostat to regulate the temperature.

The entire outdoor activity grounds are enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence is at least four feet high. The toddler activity space is enclosed by a gate separating the area from the preschool outdoor space. There is a trike outdoor acitivity area located in the middle corridor of the preschool and toddler classrooms. The LPA observed age-appropriate outdoor play equipment in safe condition, free of sharp, lose or pointed parts. The surface of the outdoor activity space has wood chipping for cushioning to prevent injury from falls. The trike area has rubber cushioning. The outdoor activity space was observed to be maintained in a safe condition and is free of hazards. There is adequate shade in the outdoor activity area. LPA observed shade for resting.

The classrooms have central air for heating and cooling.

The classrooms were clean in good repair.

Windows were in good repair free of chipping paint, dirt, insects or debris.

Classrooms have adequate lighting.

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SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

Page: 3 of 7

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: SHEPHERD OF THE VALLEY LUTHERAN CHURCH	FACILITY NUMBER: 197414470
	VISIT DATE: 12/21/2023

NARRATIVE

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The facility is equipped with landline telephones service located in the office.

Medication is stored in a safety box located in the director office.

Medication that requires refrigeration will be stored in the refrigerator located in the office.

The required postings are posted in classrooms#1 and classrooms#2 for parents and visitors to review.

Ill children will use the office area and office restroom for isolation.

LPA observed fire extinguishers in each classroom with an inspection date of 4/20/2023.

The program does not provide any lunch and snacks.

The facility has an Incidental Medical Service plan in the event that services are needed.

LPA observed trash cans having tight fitting lids.

LPA did not observe any bodies of water on the premises.

The director stated disinfectants, cleaning solutions, and other items that are dangerous to children will be stored in the upper key locked cabinets located in the classrooms.

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SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

Page: 4 of 7

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: SHEPHERD OF THE VALLEY LUTHERAN CHURCH	FACILITY NUMBER: 197414470
	VISIT DATE: 12/21/2023

NARRATIVE

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The following items were discussed:

Assistant Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 reviewed with facility representative the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA received a copy of the Result Summary dated 04/15/2023.

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SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

Page: 7 of 7

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: SHEPHERD OF THE VALLEY LUTHERAN CHURCH	FACILITY NUMBER: 197414470
	VISIT DATE: 12/21/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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

The Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following corrections are needed before a licensure will be considered.

Water Spigot Cover
Thermostat for refrigerator located in Classroom #1
Facility will provide a waiver for shared outdoor activity space with Preschoolers in Trike area.

Corrections are due by 01/02/2024.

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SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

Page: 5 of 7

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: SHEPHERD OF THE VALLEY LUTHERAN CHURCH	FACILITY NUMBER: 197414470
	VISIT DATE: 12/21/2023

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 26 27 28 29 30 31 32	An exit interview was conducted with plan of corrected items discussed and a copy of appeal rights and this report was provided to the Suzanne Legum (Director). Final license determination will be made upon review by the Licensing Program Manager and correction of the issues. Page 7 of 7

SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

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