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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418346
Report Date: 12/06/2019
Date Signed: 12/06/2019 02:20:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:BETHLEHEM LUTHERAN SCHOOLFACILITY NUMBER:
197418346
ADMINISTRATOR:FERRARA, TONIFACILITY TYPE:
850
ADDRESS:27265 LUTHER DRIVETELEPHONE:
(661) 251-6027
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY:98CENSUS: 15DATE:
12/06/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Toni FerraraTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Neal met with Director, Toni Ferrara for the purpose of a Case Management inspection of the additional playground space that will be utilized for the preschool program. There were 15 napping children observed during this inspection.

During this inspection, LPA measured additional space to be approximately 4,254 sq. ft. which equals a capacity of 57 children (based on 75 sq. ft. per child per Title 22 regulations). LPA observed both the current and the additional, new playground to be free of debris with play equipment structures in good condition. The new play structure has a shade and sand underneath for cushioning to absorb falls. Additional space is approved and meets licensing regulations.

No deficiencies were cited during this inspection.

Exit interview was conducted, report was read and a copy was given to the director.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
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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