198006310-1-24-2023-54-CC-WBIS-CNE2C6-20230124161614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198006310
Report Date: 01/24/2023
Date Signed: 01/24/2023 04:16:29 PM

Document Has Been Signed on 01/24/2023 04:16 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. PAUL'S LUTHERAN CHURCH & PRESCHOOL		FACILITY NUMBER:	198006310
ADMINISTRATOR:	NANCY BACHMAN		FACILITY TYPE:	850
ADDRESS:	2283 PALO VERDE AVENUE		TELEPHONE:	(562) 598-4729
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY:	69	CENSUS: 42	DATE:	01/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Rachel Peterson		TIME COMPLETED:	04:10 PM

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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required 1 year inspection. LPA met with Director Rachel Peterson who guided analyst on tour of the facility. This is a preschool program serving children ages two until entry in the first grade. The facility operates Monday through Friday from 7:00am to 6:00pm.

The entrance to the facility remains locked and parents and visitors must ring a doorbell for entry.Between approximately 12:40pm and 1:00pm all areas identified on the Facility Sketch were inspected. LPA observed the following classroom ratios: Yellow class (2 Teachers and 14 children); Green Room (2 Teachers and 16 children); Blue Room (3 Teachers and 13 children). LPA observed teacher-child ratios to be in compliance.

LPA observed telephone service, heating, lighting and ventilation to be satisfactory. Children have adequate cubby storage for their belongings. Napping cots are stored appropriately with bedding removed. The Parents provide sheets and blankets and weekly laundering. LPA observed drinking water with drinking cups readily available in the classrooms and outdoors. Age appropriate restrooms, sinks and toilets were inspected for good repair, water temperature, toilet paper, safety and sanitation. All available toilets and sinks are in operable condition. LPA reminded Director to store items such as hand sanitizer, cleaners, lotions, medicines and similar items in inaccessible areas (feet high or in locked cabinets).

The indoor classrooms have surfaces that appear to be clean and safe and there are age appropriate toys and reading material for children to use. There are first aid supplies in the kitchen area. Carbon monoxide detectors and smoke detectors are present in the facility. Hazardous items including including medicine and cleaning compounds are stored in inaccessible areas such as high cabinets and inaccessible office cabinets. The office is used as an isolation area for ill children and there is a cot available for children to rest until a parent picks up.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023

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. PAUL'S LUTHERAN CHURCH & PRESCHOOL	FACILITY NUMBER: 198006310
	VISIT DATE: 01/24/2023

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The facility indoors and outdoors is completely separate from a Church building on the same premises. The outdoor play area is completely surrounded by gates approximately 7 feet high. Areas around and under climbing equipment have cushioning material to cushion a fall. All play equipment, toys, materials and surfaces accessible to children appear to be age appropriate and toxic free. Director Peterson indicated there are no weapons or bodies of water at the facility and LPA did not observe any.

Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Snack were reviewed for availability, quantity, expiration dates and appropriateness for children in care. The facility has AM and PM snacks for all children and a hot lunch option Monday Wednesday and Friday. Otherwise parents provide lunch for their children. LPA observed the food and kitchen area appear to be in safe and sanitary condition. LPA informed Director to constantly assess expiration dates on food items and to continue to document dates. LPA observed drinking water available (indoors and outdoors) and trash receptacles have tight fitting covers.

Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are locked and/or inaccessible. The facility has one or more functioning smoke detectors and carbon monoxide detectors that meet statutory requirements. LPA observed a 2A10BC fire extinguisher due for service May 2023.

LPA observed the facility has digital sign in and sign out to ensure children are being properly signed in and signed out by the authorized representative (printout available if needed). LPA reviewed 10 children's files to ensure completeness and to ensure files contain proper forms such as Identification and Emergency forms, Immunization records, Health History, Personal Rights, Parents Rights, Physician's Reports, etc.on file.

At approximately 3:00pm Staff Records were reviewed to ensure the following: Criminal record clearance or criminal record exemption, education credits, current CPR/First Aid and health preventative practices, proof of immunization against pertussis and measles and influenza and/or flu declination. LPA observed at least one staff member to have current CPR (Expiration 2024). All staff have the current required Mandated Reporter training on file. The Director's CPR is was renewel in August 2022 and was required to be renewed.

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. Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication:

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023

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. PAUL'S LUTHERAN CHURCH & PRESCHOOL	FACILITY NUMBER: 198006310
	VISIT DATE: 01/24/2023

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Commonly Asked Questions about Child Care Centers and the ADA, available at:http://www.ada.gov/childqanda.htmand chairs for rest if necessary. Parents are contacted immediately if children are ill. 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. Mandatory forms for the children’s files and staff files, requirements for fire drills, earthquake drills (last drill July 2022) and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. LPA advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA advised Director that all adults 18 years of age and older providing Care & Supervision and having a continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to access forms, regulations and quarterly updates. Records for all children and staff must be maintained for three (3) years after separation from the facility. Report Unusual Incidents and/or injuries to the parent/guardian immediately and to Child Care Licensing within 24 hours and/or the next business day. Visit www.shotsforschool.org for immunization information. All care for children require supervision at all times. If away from the facility, staff must be with children at all times (especially when outdoors). There were no violations of Title 22 requirements at this 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/tion-process.

The Notice of Site Visit (LIC 9213 –must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00 Exit interview was conducted with Director Peterson and a copy of Appeal Rights (LIC 9058) was discussed and provided

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/24/2023 04:16 PM - 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. PAUL'S LUTHERAN CHURCH & PRESCHOOL	FACILITY NUMBER: 198006310
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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: Director is required to renew her CPR which expired August 2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/24/2023
	Plan of Correction
1 2 3 4	Director Peterson will provide evidence of CPR renewel.

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: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023

LIC809 (FAS) - (06/04)

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