198005392-8-19-2022-54-CC-MAYA-CHFUVT-20220819155541

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198005392
Report Date: 08/19/2022
Date Signed: 08/19/2022 03:56:14 PM

Document Has Been Signed on 08/19/2022 03:56 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	ST. TIMOTHY LUTHERAN INFANT CENTER		FACILITY NUMBER:	198005392
ADMINISTRATOR:	VELIA GUERRA		FACILITY TYPE:	830
ADDRESS:	4645 WOODRUFF AVENUE		TELEPHONE:	(562) 421-8441
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90713
CAPACITY:	24	CENSUS: 3	DATE:	08/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Director, Velia Guerra		TIME COMPLETED:	04:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On August 19, 2022 at 12:00 pm, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Director, Velia Guerra. The purpose of the inspection was to conduct the Required 1 Year inspection at the facility. Entrance Checklist – Child Care Centers (LIC 125) was provided to the Director upon arrival. The facility is currently licensed for a total of 35 children; 24 infants, ages 0 to 18 months and 11 toddlers, ages 18 months to 30 months. The facility is located on St. Timothy Lutheran Church premises. There is also a licensed preschool program located on site (License Number: 191602272). Per Director, the infant program operates Monday through Friday from 6:30 am to 6:00 pm. The Director guided LPA on a tour of the inside and outside of the facility. All areas on the facility sketch were inspected. The facility has two (2) classrooms where care is provided; Infant Classroom and Toddler Classroom. The facility also has an additional Infant Classroom that is currently vacant due to enrollment. Upon arrival, the following staff were present: Staff (S1) with 1 Toddler inside the Toddler Classroom and Staff (S2) with 2 infants inside the Infant Classroom. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Napping equipment (cribs and mats) were observed in the classrooms. Per Director, bedding is taken home weekly or as needed by parents or authorized representatives to be washed. At 12:30 pm, LPA observed loose blankets and sleep sacks inside the unoccupied cribs that were located in the Infant Classroom. Per Director, she will inform parents that blankets and sleep sacks are no longer allowed during nap time. Per Director, the isolation area is in the Director’s office. In the Director’s office, a mat can be placed on the floor for an ill child and the staff restroom is readily available if an ill child requires it. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed in each classroom.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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, 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: 08/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101439.1(f)

Infant Care Center Sleeping Equipment

(f) Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as LPA observed loose blankets and sleep sacks inside the unoccupied cribs in the Infant Classroom which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will inform parents or authorized representatives that blankets and sleep sacks are no longer allowed during nap time and will receive written confirmation from parents/authorized representatives. The Director will provide training to staff on the Safe Sleep Regulations (material provided by LPA). The Director will submit the written confirmation from parents/authorized representatives and sign-in sheet for the staff training to LPA via e-mail by September 19th.

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as the facility did not have verification of disaster and fire drills which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will conduct a disaster and fire drill at the facility, and submit the date and time of each drill to LPA via e-mail by September 19th.

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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, 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: 08/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(B)

Responsibility for Providing Care and Supervision for Infants

(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 3 children's records (C1, C2, and C3) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will ensure that staff document the 15 minute physical checks for napping infants, and will submit written verification of at least one week for C1, C2, and C3 to LPA via e-mail by September 19th.

Type B

Section Cited

CCR

101430(a)(1)

Infant Care Activities

(1) The infant care center shall develop, maintain and implement a written plan to ensure the provision of indoor and outdoor activities designed to meet the needs of infants, including but not limited to: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as the facility did not have a daily activity schedule available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will submit to LPA via e-mail a daily activity schedule for the infant and toddler classroom by September 19th.

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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, 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: 08/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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, the licensee did not comply with the section cited above in 3 out of 3 personnel records (Director, Staff (S1) and Staff (S2)) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will submit to LPA via e-mail the immunization records, including influenza, pertussis, and measles for the Director, Staff (S1), and Staff (S2) by September 19th.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 3 personnel records (Director, Staff (S1), and Staff (S2)) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	Staff will complete or renew the required Mandated Reporter (AB 1207) training and the Director will submit proof of completion to LPA via e-mail by September 19th.

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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, 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: 08/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101215.1(m)

Child Care Center Director Qualifications and Duties

(m) A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as the Director did not have on record the Preventative Health and Safety Practices certificate of completion which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will complete the Preventative Health and Safety Practices (EMSA-approved) course and submit proof of completion to LPA via e-mail by September 19th.

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as 3 out of 3 personnel present during the inspection have expired Pediatric First Aid and CPR certifications which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	Staff (Director, Staff (S1), and Staff (S2)) will renew their Pediatric First Aid and CPR certifications and the Director will submit proof of completion to LPA via e-mail by September 19th.

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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, 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: 08/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101416.2(b)(1)

Infant Care Teacher Qualifications and Duties

(b) Prior to employment, an infant care teacher shall have completed, with passing grades, at least three postsecondary semesters or equivalent quarter units in early childhood education or child development, and three postsecondary semester or equivalent quarter units related to the care of infants, at an accredited or approved college or university. (1) After employment, a teacher who has not completed the course work required in (c)(1) below shall complete, with passing grades, at least two units each semester or quarter until the education requirements are met. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 personnel records (Staff (S1) and Staff (S2)) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will submit to LPA via e-mail the personnel transcripts for the required educational units related to the care of infants by September 19th.

Type B

Section Cited

CCR

101416.2(g)

Infant Care Teacher Qualifications and Duties

(g) An infant care teacher shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 personnel records (Staff (S1) and Staff (S2)) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	Staff (S1 and S2) will complete the Preventative Health and Safety Practices (EMSA-approved) course, and the Director will submit proof of completion to LPA via e-mail by September 19th.

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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, 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: 08/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101221(b)(8)(C)

Child's Records

(b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status as specified in Section 101220, and the following health information: (C) A signed consent form for emergency medical treatment unless the child's authorized representative has signed the statement specified in Section 101220(f). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 3 children's records (C1, C2 and C3) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will submit the completed Consent for Emergency Medical Treatment (LIC 627) for C1, C2, and C3 to LPA via e-mail by September 19th.

Type B

Section Cited

CCR

101419.2(a)

Infant Needs and Services Plan

(a) Prior to the infant's first day at the center, the infant care center director or assistant director shall complete a needs and services plan for the infant. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 3 children's records (C1, C2, and C3) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will submit to LPA via e-mail the completed Needs and Services Plan for C1, C2, and C3 by September 19th.

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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, 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: 08/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101419.2(b)(2)

Infant Needs and Services Plan

(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 children's records (C1 and C2) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will submit the completed Individual Infant Sleeping Plan (LIC 9227) for C1 and C2 to LPA via e-mail by September 19th.

Type B

Section Cited

CCR

101427(b)

Infant Care Food Services

(b) There shall be an individual feeding plan for each infant. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 3 children's records (C1, C2, and C3) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will submit the completed individual feeding plan for C1, C2, and C3 to LPA via e-mail by September 19th.

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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, 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: 08/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101417(a)(1)

Toddler Component in an Infant Care Center

(1) The infant care center shall obtain written permission from the child's authorized representative for the placement of the child in the toddler program. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 child's record (C3) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	The Director will submit to LPA via e-mail the written permission from C3's authorized representative for the placement of the child in the toddler program by September 19th.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

LIC809 (FAS) - (06/04)

Page: 9 of 12

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: ST. TIMOTHY LUTHERAN INFANT CENTER	FACILITY NUMBER: 198005392
	VISIT DATE: 08/19/2022

NARRATIVE

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The facility has an operable carbon monoxide detector that was tested by the Director. The facility has smoke detectors that were tested and are operable. The fire extinguishers are fully charged and were last serviced on November 5, 2021.

Disinfectants, cleaning solutions, and other items that are hazardous to children, were made inaccessible to children in all areas. Director confirmed that there are no poisons stored at the facility. All kitchen, food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste have tight-fitting covers that are kept on and in good repair. LPA observed electrical outlet covers installed in all child care areas.

Outdoor playground equipment is in a safe condition, free of sharp, lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with sand that could absorb a fall. Per Director, the sand is inspected daily by staff prior to use. There is adequate shade in the outdoor play yard. Availability of outdoor drinking water was observed. No bodies of water were observed on the premises.

All individuals present have obtained a criminal record clearance or criminal record exemption. The Director, Staff (S1), and Staff (S2) do not have a current Pediatric First Aid and CPR certification (expired June 2022). Per Director, all staff are scheduled to renew their Pediatric First Aid and CPR certifications on August 25th at 8:30 am.

LPA conducted a record review of 3 children’s records and 3 personnel records for completeness. Based on the record reviews, 3 out of 3 children's records (C1, C2, and C3) did not have the Consent for Emergency Medical Treatment (LIC 627), Needs and Services Plan for Infants, and verification of 15 minute physical checks for napping infants. Based on the record review, 2 out of 2 children's records (C1 and C2) did not have the Individual Infant Sleeping Plan (LIC 9227) and individual feeding plan. Based on record review, 1 out of 1 child's record (C3) did not have a written permission from the child's authorized representative for the placement of the child in the toddler program.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. TIMOTHY LUTHERAN INFANT CENTER	FACILITY NUMBER: 198005392
	VISIT DATE: 08/19/2022

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Based on the record review, the Director did not have proof of completion for the Mandated Reporter Training, Preventative Health and Safety Practices, and immunization against measles and influenza on record. Based on the record review, Staff (S1) did not have proof of completion for the Mandated Reporter Training, and immunization against measles and pertussis on record. Based on record review, Staff (S2) did not have proof of completion for the Mandated Reporter Training, and immunization against pertussis. Based on the record review, S1 and S2 did not have on record the required educational units related to the care of infants. The names of children and staff whose records were reviewed were documented.

Children's roster was reviewed and is current. Sign-in and sign-out sheets were reviewed; all children present were signed in. Based on record review, the facility did not have verification of disaster and fire drills and a daily activity schedule available for review. Per Director, transportation is not provided by the facility.

The facility provides the children with morning and afternoon snacks. Per Director, children bring their own lunch each day from home. LPA observed the food menu posted. During the inspection, snacks were reviewed for availability and quantity.

First Aid supplies were observed and kept in the Infant Classroom. According to the Director, medication is only administered to a child when accompanied with a doctor's note and medication is stored in a cabinet located in the classroom. At this time, no children enrolled in care require any medication.

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. When any IMS is provided, an updated 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.

Director was reminded that all adults 18 and over, 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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. TIMOTHY LUTHERAN INFANT CENTER	FACILITY NUMBER: 198005392
	VISIT DATE: 08/19/2022

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LPA discussed the safe sleep regulations with the Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA advised the Director on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at: www.ccld.ca.gov.

LPA discussed the Technical Support Program (TSP) with the Director, who stated that she will determine an agreement to participate at a later time.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Deficiencies were cited in accordance with California Code of Regulations, Title 22, Division 12 (refer to deficiency pages).

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Director, Velia Guerra. Appeal Rights were discussed, and a copy was provided to the Director.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

LIC809 (FAS) - (06/04)

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