198018931-10-17-2019-54-CC-AJLO-BH2QAV-20191017120034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018931
Report Date: 10/17/2019
Date Signed: 10/17/2019 12:00:41 PM

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:	CONCORDIA LUTHERAN KING'S CLUB		FACILITY NUMBER:	198018931
ADMINISTRATOR:	SUSAN JENNINGS		FACILITY TYPE:	840
ADDRESS:	13633 183RD ST.		TELEPHONE:	(562) 926-2491
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	30	CENSUS: 0	DATE:	10/17/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Susan Jennings, Director		TIME COMPLETED:	12:15 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	An unannounced Annual Random Inspection was conducted on this day by Licensing Program Analyst (LPA) Lucero. Facility is currently licensed for a capacity of 30 school age children. Licensing staff met with Director Susan Jennings who guided LPA on an indoor and outdoor tour of the facility. The program hours are Monday through Friday from 6:30 - 8:45AM; 2:45 - 6:30PM; 12:50PM to 6:30PM. Operation of program follows the school district calendar. No children were present as they were currently attending school. Program will be open to children who are enrolled at Cerritos Elementary school. No transportation services will be provided. A teacher will walk children to Concordia site. Per the Director, the program only operates in classroom #3 located downstairs and in classroom #23 which is located upstairs. Director stated that licensed classrooms #4 and #22 are not being used and would like to withdraw them from the license. LPA instructed Director that a new facility sketch will need to be submitted to the department. LPA determined from measurements taken from the initial pre-license inspection allows facility to maintain their current capacity of 30 children. Furniture and equipment was inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings was observed. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. Toys observed to be clean. A first aid kit is kept in the classroom. Carbon monoxide detectors and smoke detectors are present in the facility and in operational condition. Fire extinguishers have been serviced in July 2019. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. Facility provides an afternoon snack to children. Child eat lunch at school.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: CONCORDIA LUTHERAN KING'S CLUB	FACILITY NUMBER: 198018931
	VISIT DATE: 10/17/2019

NARRATIVE

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LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have 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 obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.

The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised to visit www.shotsforschool.org for immunization information.

Director advised that indoor and outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.

These forms may also be downloaded from our website: www.ccld.ca.gov

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

Exit interview, copy of report was given. Appeal rights were issued and discussed.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: CONCORDIA LUTHERAN KING'S CLUB	FACILITY NUMBER: 198018931
	VISIT DATE: 10/17/2019

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Outdoor equipment was inspected for safety, cushioning material, good repair and appropriateness. Required shade, drinking water and fencing were inspected. Drinking water is brought out to yard. LPA Lucero advised Director that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.

Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. CPR card expires in 08/24/21 for staff #1. Inspection of required forms made.

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

The following was discussed with the Director:
Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills 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. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

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