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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197420035
Report Date: 11/21/2024
Date Signed: 11/21/2024 11:30:59 AM

Document Has Been Signed on 11/21/2024 11:30 AM - 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:BETHLEHEM LUTHERAN SCHOOLFACILITY NUMBER:
197420035
ADMINISTRATOR/
DIRECTOR:		KANDILIAN, MARYFACILITY TYPE:
840
ADDRESS:12227 BALBOA BLVD.TELEPHONE:
(818) 368-6947
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 0DATE:
11/21/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Mary Kandilian, DirectorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 11/21/2024 at 08:00 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced 3 Year Annual Required Inspection. Facility is located at 12227 Balboa Blvd., Granada Hills, CA 91344. LPA identified self and met with Sandra Valdivia, Assistant Director, LPA identified reason for visit and provided Entrance Checklist -Child Care Centers (LIC 125) to help facilitate the inspection. Mary Kandilian, Director arrived shortly after.

Facility Representative (FR) Sandra Valdivia, Assistant Director allowed entry to facility and provided LPA a guided tour of the inside and outside of the facility. The facility is currently licensed for a capacity of 25, per FR they currently have 14 enrolled. The facility hours of operation are currently Monday thru Friday from 07:00 AM to 06:00 PM.

Required postings were observed posted in school lobby.

The facility includes Infant License #19402147 with 3 Infant Classrooms and Preschool License #191402147 with 5 classrooms. The facility is for school age and is made up of 1 classroom 5 year olds to 10 year olds with 2 staff.

Beginning at 08:10 AM, LPA observed the following in the classroom. The furniture, toys, and equipment were inspected for age appropriateness and were in good repair. There were hooks used for each child to store their belongings. Drinking water was readily available with individual water bottles and pitchers of water are available. The restroom(s) were inspected for safety and sanitation. There were age-appropriate sinks and toilets located outside the classroom and water was available, water temperature was appropriate, and toilet paper was provided. There is telephone service, heating, lighting and ventilation were evaluated for safety and comfort.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: BETHLEHEM LUTHERAN SCHOOL
FACILITY NUMBER: 197420035
VISIT DATE: 11/21/2024
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LPA observed a first aid kits located in the classroom and inventoried for necessary supplies. LPA observed a device in the classroom, per FR it is a combination fire and carbon monoxide detector. LPA observed smoke detector via fire alarm. Disaster drill log was available, and the last disaster drill was conducted on 11/15/2024. Per FR, isolation area for sick children is in the office. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. LPA observed cleaning solutions stored in a high cabinet with a child safety latch.

Beginning at 08:15 AM, LPA observed the kitchen area/ food preparation area, per FR snacks are provided and hot meals are offered.

Beginning at 08:25 AM, LPA toured the outdoor play area and observed playground equipment in safe condition, free of sharp, loose, or pointed parts, in good repair and age appropriate. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Children have access to the climbing structure located in the play area and there is rubber material underneath and around the structure to absorb falls. There is adequate shade in the play yard. During outdoor play, children have access to drinking water with the use of individual bottles of water and fountains for refills. LPA advised that no children shall be left without the supervision at any time. There is no swimming pool or other bodies of water on the premises.


Beginning at 09:15 AM, staff and children’s records were reviewed for completeness. Inspection of required forms was made and documented on the LIC 857 for children and the LIC 859 for staff. Criminal Record Clearances were reviewed for adults. CPR card expires on 07/2026 for Assistant Director. Inspection of required forms were discussed.

LPA’s record review shows teacher-child ratios are maintained, and staff names were recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. LPA observed no children signed in at time of inspection. Personal Rights of children were observed by LPA.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: BETHLEHEM LUTHERAN SCHOOL
FACILITY NUMBER: 197420035
VISIT DATE: 11/21/2024
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This facility currently has no children who require Incidental Medical Services (IMS) and has provided Incidental Medical Services - IMS. LPA reviewed storage of "medication and equipment/supplies, and reviewed children's, personnel, and administrative records.

For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care­ centers/.

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 with the Written Directives outlined in PIN 21-21.1-CCP.

Facility Representative 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.

To improve the quality and value of the new inspection process, a survey may be sent to the
email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: BETHLEHEM LUTHERAN SCHOOL
FACILITY NUMBER: 197420035
VISIT DATE: 11/21/2024
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are being cited.

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview was conducted with Sandra Valdivia, Assistant Director including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4