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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002009
Report Date: 09/12/2019
Date Signed: 09/12/2019 01:07:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:COMMUNITY PRESBYTERIAN PRESCHOOLFACILITY NUMBER:
198002009
ADMINISTRATOR:KIM, JINAFACILITY TYPE:
850
ADDRESS:13701 HILLSBOROUGHTELEPHONE:
(562) 902-9282
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:56CENSUS: 21DATE:
09/12/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Jina Kim, DirectorTIME COMPLETED:
01:20 PM
NARRATIVE
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An unannounced annual inspection was conducted by the Licensing Program Analyst (LPA) Torrence on 09/12/2019. During this inspection, LPA Torrence met with Director Jina Kim, who guided analyst on a tour of the Early Childhood Setting indoors and outdoors. Census was as follow: Room 1; four children, with one staff supervising, Room 2; seven children; with one staff supervising, and Room 4; 10 children, with one staff supervising. This program operates from 8:00 a.m. to 4:00 p.m., Monday-Friday, serving ages 2 to 5. A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Equipment and furniture were inspected to ensure it's in good condition, free of sharp, loose or pointed parts. Toilets and sinks were inspected to ensure they are safe and in a sanitary operating condition, floors were inspected for safety and cleanliness. This facility does provide food for the children. This facility provides AM snack and lunch is brought from home. LPA verified that a menu was posted. Per Director, there are no weapons, firearms in the facility. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material.

Staff's files were reviewed for education verification, CPR/First Aid, and new immunization requirements; such as, Measles, Pertussis, and Influenza vaccines. The staff files are current with the new immunization requirements. A sample of children's files were reviewed for completeness. The facility has a current children’s roster and an updated fire/disaster drill.

SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: COMMUNITY PRESBYTERIAN PRESCHOOL
FACILITY NUMBER: 198002009
VISIT DATE: 09/12/2019
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Incidental Medical Services-IMS policy was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

The facility representative was informed that licensing updates, regulations, and forms are located on the CCLD website: www.ccld.ca.gov . Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. LPA provided licensee a copy of the Effect of Lead Exposure handout.

There was no deficiency cited per CA Code of Regulations Title 22, Division 12.



Report was reviewed and discussed. The licensee was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights. The Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. This report is to be on file and accessible for public review at the facility for at least 3 years.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019
LIC809 (FAS) - (06/04)
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