198014862-3-29-2022-54-CC-ECHZ-CCYV4U-20220329160655

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014862
Report Date: 03/29/2022
Date Signed: 03/29/2022 04:07:03 PM

Document Has Been Signed on 03/29/2022 04:07 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:	CALVARY CHAPEL CHRISTIAN PRESCHOOL		FACILITY NUMBER:	198014862
ADMINISTRATOR:	BLANCA SANCHEZ		FACILITY TYPE:	850
ADDRESS:	12808 WOODRUFF AVENUE		TELEPHONE:	(562) 299-9100
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	95	CENSUS:	DATE:	03/29/2022
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Christy Leonard and Scott Lasch		TIME COMPLETED:	02:30 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	A virtual Informal Office meeting was conducted on this date via Teams with Facility Representatives, Christy Leonard and Scott Lasch. Also, in attendance were Licensing Program Analyst (LPA) Elka Chavez and Licensing Program Manager (LPM) Karen Chambers. The purpose of the informal meeting was to discuss Criminal Record Clearance and Child Care Center Director Qualifications and Duties for Christy Leonard. During this meeting the deficiencies cited on March 18, 2022 where it was noted that Christy Leonard the facility director is in the premises without a Criminal Record Clearance, and Christy Leonard is still in the process of completing trainings for Child Care Center Director were discussed. The Facility Representative noted that they have appointed Denisse Cardenas as the facility director pending Christy Leonard’s Criminal Record Clearance and completing training. The following is to be submitted no later than 4/01/22 for Denisse Cardenas: 1. Proof of immunizations (MMR, Tdap and Influenza or declination statement 2. Proof of Mandated Reporter Training 3. Proof of Experience (Letters from previous employers) for Denisse 4. Board Resolution authorizing delegation to Denisse Cardenas The following is to be submitted once Criminal Record Clearance is granted for Christy Leonard: 1. LIC 308 Designation of Responsibility 2. LIC 501 Personnel Record 3. LIC 503 Health Screening 4. LIC 9052 Employee Rights

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

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: CALVARY CHAPEL CHRISTIAN PRESCHOOL	FACILITY NUMBER: 198014862
	VISIT DATE: 03/29/2022

NARRATIVE

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5. LIC 9108 Statement Acknowledgement to Report Child Abuse
6. Proof of Step II Orientation
7. Proof of Pediatric First Aid and CPR
8. Proof of Health and Safety Training, including one-hour nutrition training
9. Proof of Immunization (MMR, Tdap, Influenza and TB)
10. Proof of Mandated Reporter Training
11. LIC 500 Personnel Report

It was noted that all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility obtain a California clearance or a criminal record exemption as required by the Department. Christy Leonard and Scott Lasch were reminded that until required clearances are received for Christy, she shall not be at the preschool school or having any contact with the preschool children.

Exit interview was conducted with Facility Representatives, Christy Leonard and Scott Lasch who were in agreement with the above. A copy of this report shall be emailed to the Facility Representative for signing and returned to the Department. Appeal rights were explained and will be mailed with the signed copy of this report provided.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC809 (FAS) - (06/04)

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