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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019818
Report Date: 09/14/2021
Date Signed: 09/14/2021 04:42:39 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ST. JOHN'S LUTHERAN PRESCHOOLFACILITY NUMBER:
198019818
ADMINISTRATOR:LORENA BESSMANFACILITY TYPE:
850
ADDRESS:417 N. 18TH STREETTELEPHONE:
(323) 722-9885
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:60CENSUS: 19DATE:
09/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Richard Fulmer, Administrator TIME COMPLETED:
05:00 PM
NARRATIVE
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On 09/14/2021 at 1:00 pm, Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced required inspection. A previous attempted visit was conducted on 9/3/2021. A risk assessment was conducted prior to entering the facility appropriate PPE was used. LPA was led into the facility by Director, Lorena Bessman, who was alone in the facility- she called Administrator Richard Fulmer who arrived at 1:10 pm and guided the LPA on a tour of the facility. This is a preschool age program licensed for 60 children which operates Monday – Friday from 6:30 AM – 6:00 PM. Per Administrator, there are 29 children enrolled.

All areas identified on the Facility Sketch were inspected. Upon arrival, LPA was led into the facility by Director Laura Bessman who stated that she was by herself and was calling Administrator. LPA observed 1 child had followed Director out of the classroom. During the inspection of the 2-3 year old classroom- LPA observed that the Director had 19 children by herself. Two children were awake, 1 being out of the cot. During the walk through of the classroom other children began waking up. Per Director and administrator the morning teacher had left at 12:30pm and the closing teacher would be arriving at 1:30 pm. Teacher-child ratios were observed not to be in accordance with Title 22 Regulations. LPA Lopez observed the preschool classroom to be emptied- Per administrator that classroom was used in the morning. Staff names were recorded.

LPA observed the facility to be clean, sanitary and in good repair. Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All toilets and washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, the Director’s office is used as an isolation area. A cot will be brought into the office. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 6
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: ST. JOHN'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 198019818
VISIT DATE: 09/14/2021
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Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides AM snack and PM snack. Children bring their own lunches. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and LPA inspected that any contaminated food is discarded immediately. There is drinking water available in all indoor classrooms in forms of sippy cups and are refilled when needed. LPA observed water fountains in the outdoor area- LPA recommended water fountains no to be used during COVID. Per administrator, children will bring their sippy cups outside in addition to a water jug. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Administrator states that there are poisons stored in the janitor closet.

At 1:30 pm LPA observed that there is operable smoke alarm system in the facility. Administrator called the alarm system and was informed that it did not include carbon monoxide detectors. Administrator, purchase the carbon monoxide detector during the inspection and will submit proof of installation. Disaster drill log was available, last drill was conducted on 7/23/2021.

Outdoor play equipment was observed-. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The administrator states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit. LPA observed an additional yard space that it is made inaccessible for the use of children, by a locked gate. Per Administrator that area is not being used due to COVID.

Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. Staff Records were reviewed to ensure that a health screening report is on file. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed.

LPA also issued the Review of Staff records (LIC 859) to the licensee during this inspection. The LIC 857 and the LIC 859 documents the staff and children’s files that were reviewed during this inspection.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: ST. JOHN'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 198019818
VISIT DATE: 09/14/2021
NARRATIVE
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SB792 (Immunization Requirements for Staff and Employees) was discussed with the Administrator and Director. Staff do have immunization documentation.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. Upon file review Staff 1-5 have expired AB1207 .


Medication: Incidental Medical Services (IMS) were discussed.. 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:


· Reporting Requirements.
· The facility shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations.
· All personnel shall be in good health and shall be physically and mentally capable of performing assigned tasks; personnel that pose a threat to the health and safety of children shall be relieved of their duties.
· All personnel shall be given on the job training in housekeeping, sanitation principles and universal health precautions.

LPA Lopez consulted with Administrator regarding COVID-19 health and safety guidelines on this date, Licensing staff observed COVID- 19 postings posted in the day care on this date. A RAST inspection is on file- During this inspection LPA discussed the mask mandate and Social and Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: ST. JOHN'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 198019818
VISIT DATE: 09/14/2021
NARRATIVE
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LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d.

Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.

A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided.

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 reprehensive. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Administrator Richard Fulmer, who was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of the report.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: ST. JOHN'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 198019818
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2021
Section Cited

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10230(c) Activties: A teacher-child ratio of one teacher supervising 24 napping children is permitted provided that the remaining teachers necessary to meet the overall ratio specified in Section 101216.3(a) are immediately available at the center. This requirement was not met as evidenced by: Based on interviews and LPA's
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observations the Director was by herself with 19 children. LPA observed 2 children awake, 1 of them walking around. Per administrator and Director the opening teacher was off at 12:30 pm and the next teacher would arrive at 1:30 pm. This poses an immediate risk for the health and safety of children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: ST. JOHN'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 198019818
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2021
Section Cited

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1596.954- Carbon monoxide detectors required; inspection. Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for
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 the presence of these detectors during inspections. This requirement is not met as evidenced by: Based on LPA's interviews and observation the facility does not have a carbon monoxide. This poses a potential risk for the health and safety of children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6