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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197420035
Report Date: 07/06/2022
Date Signed: 07/06/2022 12:57:37 PM


Document Has Been Signed on 07/06/2022 12:57 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 SCHOOLFACILITY NUMBER:
197420035
ADMINISTRATOR:KANDILIAN, MARYFACILITY TYPE:
840
ADDRESS:12227 BALBOA BLVD.TELEPHONE:
(818) 368-6947
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:12CENSUS: 9DATE:
07/06/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:11 AM
MET WITH:Director, Mary KandilianTIME COMPLETED:
01:00 PM
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On 7/06/2022 at 8:11 a.m. Licensing Program Analyst (LPA) Deborah Lowe met with Director, Mary Kandilian. The purpose of the visit was an announce case management inspection at the facility to ensure that health, safety and personal rights as requires by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. There were 9 school age children present during this inspection. This is a capacity increase application for 30 school age children, ages 5 years to 10 years old. The School Age classrooms will operate Monday – Friday before school 7:00 am – 8:00 am, after school Monday, Wednesday, Thursday, Friday 2:30 pm – 6:00 pm and Tuesday 1:40 pm – 6:00 pm. When local public schools are on vacation School Age classroom will operate 7:00 am -6:00 pm

The fire clearance was approved on 4/15/2022. Licensee has a Preschool license 191201596 and an Infant license 197402147 at the facility.

LPA Lowe toured the currently licensed school age classroom and measured the new designated school age classroom along with the outdoor play area. The facility has a total of 1 School age classroom. Facility is requesting to change the school age classroom to the multi-purpose room. The previously licensed school age classroom will no longer be used for school age childcare once application is approved. Children will have access to 2 sinks, 2 toilets, and 1 urinal.

Classroom measurements are:

Indoor total measurements: Requested school age classroom total 886.74 sq ft divided by 35 sq feet = 25 school age children.

Outdoor Play measurements are:

Outdoor total measurements: 12239.40 sq ft divided by 75 sq ft = 163 children. Facility currently has a shared outdoor space waiver with their preschool license. Facility is requesting to continue with a shared outdoor space waiver.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022
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: BETHLEHEM LUTHERAN SCHOOL
FACILITY NUMBER: 197420035
VISIT DATE: 07/06/2022
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Indoor/Children’s Area:

All outdoor and indoor passageways, inclines, ramps, open porches and other areas of potential hazard were observed to be free of obstruction. The child care center was observed be clean, safe, sanitary and in good repair. Floors of all rooms observed were observed to have a surface that is safe and clean. A comfortable temperature for children was observed. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. Tables and chairs were observed to be meet the needs of the children. All play equipment and materials used by children were observed to be age-appropriate. LPA observed individual storage space for children’s clothing and personal belongings. All materials and surfaces accessible to children, including toys, were observed to be free of toxic substances.

Facility is a combination program with an infant and preschool license, indoor activity space provided for school-age child care center children was observed to be physically separated from space provided for infant care and child care center children.

Drinking water from a noncontaminating fixture and containers was observed to be readily available both indoors and in the outdoor activity area. Per Director, facility has a monthly pest control provider to ensure the facility is free of insects, spiders, and rodents. LPA advised all containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof. LPA Lowe observed classroom trash cans to have lids. Bathroom trash cans were observed in need of lids. No fireplaces or open face heaters were observed. All window screens were observed to be in good repair and free of insects, dirt and debris.

Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children were observed to be stored where inaccessible to children. LPA advised the licensee shall maintain the following first-aid supplies in a location accessible to staff but inaccessible to children: LPA observed a current edition of a first-aid manual, sterile first-aid dressings, bandages, roller bandages, adhesive tape, scissors, tweezers, thermometer, and antiseptic solution.

LPA Lowe observed Chandler Hall as the designated isolation area should a child become ill at the facility. Chandler Hall is located between the Directors office and the kitchen with access doors to both the Directors office and the kitchen. The isolation area was observed be located to afford easy supervision of children by center staff. Director stated a staff member will remain in Chandler Hall with the child. The isolation area was

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
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 SCHOOL
FACILITY NUMBER: 197420035
VISIT DATE: 07/06/2022
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observed to be equipped with 2 couches. LPA advised the isolation area shall not be located in the kitchen area or the general-use toilet area.

LPA Lowe observed carbon monoxide detector located in the school age classroom, LPA heard a successful test. LPA observed facility to have a working telephone service on the premises.

Facility utilizes an electronic sign in/out system with use of parent fingerprints. LPA Lowe observed a computer located in the front lobby with a fingerprint scan attachment.

Director stated the staff ensure that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted by conducting a visual check of children at morning drop off.

LPA advised smoking is prohibited on the premises of a child care center as specified in Health and Safety Code Section 1596.795(b).

LPA advised there shall be at least 35 square feet of indoor activity space per child based on the total licensed capacity. Based on the total licensed capacity, one toilet and one handwashing fixture shall be maintained for every 15 children, or fraction thereof.

Restrooms:

School age has access to two single use restrooms located just outside of the new requested school age classroom. One restroom was observed with one toilet and one sink, the 2nd restroom was observed with one toilet, one sink, and one urinal. All toilets, handwashing and bathing facilities were observed to be maintained in safe and sanitary operating condition. LPA advised additional equipment, aids and/or conveniences shall be provided as needed in centers that serve children with physical disabilities.

LPA advised toilets used by school-age children shall provide individual privacy. Toilet facilities shall not be used simultaneously by children of both sexes

LPA advised hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by children to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

LPA Lowe did not observe hot water available. LPA advised notwithstanding (e) and (e)(1) above, handwashing fixtures shall not be required to deliver hot water.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BETHLEHEM LUTHERAN SCHOOL
FACILITY NUMBER: 197420035
VISIT DATE: 07/06/2022
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Staff restroom located facing the courtyard designated for use by children who are ill, for use by staff, and for emergency use. This toilet and handwashing fixture was observed to be conveniently located in relation to the isolation area.

Outdoor:

Facility current has an approved shared outdoor activity space waiver with the Preschool License. LPA observed a shaded rest area for the children. LPA observed the outdoor area to be free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. LPA Lowe observed the areas around and under high climbing equipment, swings, slides and other similar equipment to be cushioned with material that absorbs falls.

Little Tykes play kitchen and log cabin were observed to be in need of repair with cracked or broken parts. Director stated items will be removed from facility.

LPA advised sandboxes shall be inspected daily and kept free of hazardous foreign materials.

The playground was observed to be enclosed by a fence around the exterior of the facility to protect children and to keep them in the outdoor activity area . The fence was observed to be at least four feet high.

LPA advised any construction or equipment that could pose a hazard in the outdoor activity area shall be made inaccessible to children in care. This shall include, but not be limited to, incinerators, air- conditioning equipment, water heaters, and fuse boxes.

LPA Lowe did not observe any pools or other bodies of water at the facility.

LPA advised there shall be at least 75 square feet per child of outdoor activity space based on the total licensed capacity.

Health Related Services:

Medications were observed to be kept in a safe place inaccessible to children located in a locked box on the wall in the Directors office. LPA Lowe observed a small box with lock attached to the inside of the refrigerator labeled medication for any medication that requires refrigeration.

Facility is using LIC 9221 Parent Consent for Administration of Medications and Medication Chart as their

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
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 SCHOOL
FACILITY NUMBER: 197420035
VISIT DATE: 07/06/2022
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written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given.

Food Service:

LPA advised all food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified by Title 7, Code of Federal Regulations, Part 226.20, (Revised January 1, 1990) Requirements for Meals, for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.

LPA Lowe advised all foods or beverages capable of supporting the rapid and progressive growth of microorganisms that can cause food infections or food intoxications shall be stored in covered containers at 45 degrees F (7.2 degrees C) or less. LPA Lowe observed commercial size refrigerator in kitchen with thermometer.

LPA advised pesticides and other similar toxic substances shall not be stored in food storerooms, kitchen areas, food-preparation areas, or areas where kitchen equipment or utensils are stored. LPA did not observe any pesticides or similar toxic substances.

LPA observed soaps, detergents, cleaning compounds or similar substances stored in areas separate from food supplies in a locked cabinet.

LPA Lowe observed the kitchen, food-preparation and storage area to be clean and free of litter and rubbish. LPA advised children's play activities, unless such activities are part of a supervised food-education program shall not occur in the kitchen.

Facility provides morning and afternoon snack. Lunch is catered into facility for all children.

Postings:

LPA Lowe observed the following postings located in the front lobby and in a window case located just outside the front door: The license, LIC 613A (9/96), the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster, LIC 610 Emergency Disaster Plan with the telephone number of the local health department, information on child passenger restraint systems, and a contingency plan for action during fires, floods and earthquakes.

LPA observed the menu to be in writing and current week posted in the front window case. Director stated

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
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 SCHOOL
FACILITY NUMBER: 197420035
VISIT DATE: 07/06/2022
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the menu is also shared on the class dojo communication app the facility uses with families. LPA advised copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request.

LPA Lowe reviewed facilities disaster and mass casualty plan of action located in the office.

Transportation:

Motor vehicles are not used to transport children. Facility staff walk with school age children to and from local elementary school El Oro Way.

The following items were discussed: Facility representative 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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)/ (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

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.

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 platform.

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.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7
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 SCHOOL
FACILITY NUMBER: 197420035
VISIT DATE: 07/06/2022
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The following corrections are needed before a capacity increase will be considered. Corrections are due by 07/08/2022:

· Trash cans located in both school age restrooms require lids.

· Little Tykes outdoor log cabin and play kitchen were observed with cracks and need to be repaired. Director stated they will be removed.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the facility representative Director, Mary Kandilian.

Final capacity increase determination will be made upon review by the Licensing Program Manager and correction of the above issues.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
LIC809 (FAS) - (06/04)
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