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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019818
Report Date: 09/16/2021
Date Signed: 09/16/2021 02:12:45 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: 17DATE:
09/16/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Richard Fulmer, Administrator TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced POC (plan of correction) inspection to insured that the Type A deficiency cited on 9/14/2021 has been cleared. LPA met with Richad Fulmer, Administrator who guided LPA on a tour of the facility.

The following was observed:
- LPA observed 2 teachers with 17 children in the 2-3 year old classroom. The preschool classroom was emptied.

At this time, the facility is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

LPA’s advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov.

LPA cleared deficiency on this date- LPA issued POC clearance letter during the visit.

The Notice of Visit (LIC 9213)- must remain posted for 30 days during the hours of operation after each site visit by licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Richard Fulmer, Administrator, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
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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