198005392-2-14-2025-54-CC-JCUT-DDVNEZ-20250214092442

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198005392
Report Date: 02/13/2025
Date Signed: 02/14/2025 09:25:09 AM

Document Has Been Signed on 02/14/2025 09:25 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	ST. TIMOTHY LUTHERAN INFANT CENTER		FACILITY NUMBER:	198005392
ADMINISTRATOR/ DIRECTOR:	VELIA GUERRA		FACILITY TYPE:	830
ADDRESS:	4645 WOODRUFF AVENUE		TELEPHONE:	(562) 421-8441
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90713
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 7	CENSUS: 7	DATE:	02/13/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:05 AM
MET WITH:	Director, Beatriz Villea		TIME VISIT/ INSPECTION COMPLETED:	04:40 PM

NARRATIVE

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Licensing Program Analysts (LPA) Jonnisha Culbert conducted an unannounced annual/random inspection at the facility noted above. LPA met with Director Beatriz Villela, discussed the purposes of the visit, and provided Entrance checklist for Childcare Centers (LIC 125). They guided analysts on a tour of the facility. This is an Infant center which consists of one classroom. The program operates from Monday through Friday from 7:30am to 5:30pm. The program offers care to children from 0 to 18 months. Present during today's inspection were 7 infants, Director, and 2 staff.

Due to time constraints, LPA expressed to Director that they will return on a later date. 4 Type B citations were addressed during today’s visits. Any other citations that need to be addressed will be discussed on a future date alone with a full report for today’s visit.

Exit interview conducted, appeal rights were given, and report was reviewed with the Director, Beatriz Villela.

Karen Chambers	TELEPHONE: (323) 981-3350
Jonnisha Culbert	TELEPHONE: (323) 246-2016
	DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025

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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Document Has Been Signed on 02/14/2025 09:25 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. TIMOTHY LUTHERAN INFANT CENTER	FACILITY NUMBER: 198005392
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

101430(a)(3)(A)(4)

Infant Care Activities

(A) Staff shall place infants up to 12-months of age on their backs for sleeping. (4) Infants with an Individual Infant Sleeping Plan [LIC 9227 (3/20)] that have Section C of the form completed and signed by an authorized representative shall be placed on their back when first laid down to sleep. In the event the infant changes position, the infant may remain in the alternative position. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above in 3 out of 3 staff did not have proof of immunization against pertussis and measles which poses a potential health and safety risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	Per Director, they will have staff obtain proof of immunization against pertusiss and measles and email it to LPA J. Culbert by proof of correction date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Karen Chambers	TELEPHONE: (323) 981-3350
Jonnisha Culbert	TELEPHONE: (323) 246-2016
	DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 02/14/2025 09:25 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. TIMOTHY LUTHERAN INFANT CENTER	FACILITY NUMBER: 198005392
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above in 1 out of 3 staff does not have a Health Screening Report (LIC 503) which poses a potential health and safety risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	Per Director, Staff will have form completed by a licensed physician and Director will email the form to LPA J. Culbert by plan of correction date.

Type B

Section Cited

CCR

101419.3(a)

Modifications to Infant Needs and Services Plan

(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview , the licensee did not comply with the section cited above in 3 out of 3 infants does not have a needs in service plan that is updated quartely which poses a potential health safety risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	Per Director, they will have Teacher complete and update forms with child's authorized represenative and email copies to LPA J. Culbert by plan of correction date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Karen Chambers	TELEPHONE: (323) 981-3350
Jonnisha Culbert	TELEPHONE: (323) 246-2016
	DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025

LIC809 (FAS) - (06/04)

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