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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018207
Report Date: 07/05/2022
Date Signed: 07/06/2022 07:58:39 AM


Document Has Been Signed on 07/06/2022 07:58 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:GRACE LUTHERAN CHURCH INFANT CARE CENTERFACILITY NUMBER:
198018207
ADMINISTRATOR:CHRISTY ARREGUINFACILITY TYPE:
830
ADDRESS:17880 E. COVINA BLVDTELEPHONE:
(626) 967-5855
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY:16CENSUS: 5DATE:
07/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Christy Arreguin, DirectorTIME COMPLETED:
12:45 PM
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On 7/5/2022 at 9:32M, Licensing Program Analyst (LPA) Thelma Razo arrived at the facility to conduct an unannounced Required – 1 year inspection. LPA introduced self with Director Christy Arreguin and stated the purpose of the visit. A COVID-19 risk assessment was made prior to entry to the facility. LPA provided Director with a copy of the LIC 126 Entrance Checklist to facilitate the inspection. This is an infant program which consists of one classroom and one crib room. Facility hours of operation is from Monday to Friday, 6:30 AM to 6:00 PM. This facility has a preschool component LIC #191500272.

LPA was guided to a facility tour by Director Arreguin at 10:03PM. All areas identified on the Facility Sketch were inspected. The infant program is located adjacent to the center's pre-school program. The following staff were present during this inspection: Staff #1, and Staff #2 with 5 infants. The facility was observed to be within the license capacity and limitations. The following was observed during the tour of the facility:

Furniture and equipment were inspected for age appropriateness and good repair. The facility has enough napping equipment, feeding chairs, and changing tables.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRACE LUTHERAN CHURCH INFANT CARE CENTER
FACILITY NUMBER: 198018207
VISIT DATE: 07/05/2022
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Infants in this program are from the age of 6 weeks to 24 months. Infants sleep on the cribs. No infants were observed to be swaddled. Telephone service (land line), heating, lighting and ventilation were evaluated. Infants have their own cubby to store their belongings. Bedding is provided by the parents and is washed at the end of the day, or as needed. Per Director, the isolation area is located in the hallway next to the staff restroom. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in the classroom. The children have their own bottles with their names written on them. First Aid supplies were observed in the classroom in a cabinet. Disinfectants, cleaning solutions, and other items that are dangerous to infants, were inaccessible to infants. All floors were observed to be clean and safe. All materials accessible to infants were observed to be toxic free.

Per Director, there are no firearms stored on the premises. There are no pools or bodies of water at the facility.
Staff stated that there were no poisons stored at the facility. Carbon monoxide and smoke detectors were tested and were working. All food preparation areas 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, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. Infants are on formula and soft foods. Brunch and snack menu was Page 2 of 5

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRACE LUTHERAN CHURCH INFANT CARE CENTER
FACILITY NUMBER: 198018207
VISIT DATE: 07/05/2022
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observed to be posted. Food in refrigerator was labeled. Sink counter tops were clean and free of clutter or standing food.

The outdoor playground was observed to be physically separate from the preschool component. Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. The outdoor surface is cushioned with material that absorbs a fall. There is adequate shade in the play yard. LPA advised that no children shall be left without the supervision of a teacher at any time.

Children’s Records were reviewed. Infant Needs and Service plans were viewed and observed to be in each infant's file. Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative 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.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRACE LUTHERAN CHURCH INFANT CARE CENTER
FACILITY NUMBER: 198018207
VISIT DATE: 07/05/2022
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LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff present have proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present have proof of TB negative test, measles, pertussis, and influenza. All staff have been given on the-job training on sanitation principles, housekeeping, including universal health precautions. All individuals present have obtained a criminal record clearance or criminal record exemption as a condition of employment. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

According to Director, there are currently no infants on medication.
Medication: This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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
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

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRACE LUTHERAN CHURCH INFANT CARE CENTER
FACILITY NUMBER: 198018207
VISIT DATE: 07/05/2022
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Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.

There were no deficiencies cited during today’s inspection.

A Notice of Site visit was posted and must remain for 30 days.

Exit interview conducted and report was reviewed with Director Christy Arreguin.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022
LIC809 (FAS) - (06/04)
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