240405513-2-5-2025-04-CC-PKVE-DDLSBT-20250205124427

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 240405513
Report Date: 02/05/2025
Date Signed: 02/05/2025 12:45:26 PM

Document Has Been Signed on 02/05/2025 12:45 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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	ST. PAULS' EVANGELICAL LUTHERAN CHURCH OF MERCED		FACILITY NUMBER:	240405513
ADMINISTRATOR/ DIRECTOR:	FAULKNER, ANGELIQUE		FACILITY TYPE:	850
ADDRESS:	2916 N. MCKEE ROAD		TELEPHONE:	(209) 383-5672
CITY:	MERCED	STATE: CA	ZIP CODE:	95340
CAPACITY: 55	TOTAL ENROLLED CHILDREN: 55	CENSUS: 34	DATE:	02/05/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Melanie Sneed		TIME VISIT/ INSPECTION COMPLETED:	12:45 PM

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On 02/05/2025 Licensing Program Analyst (LPA) Pa Kou Vue conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Facility Representative Melanie Sneed and explained the purpose of today’s inspection. LPA toured the facility indoors and outdoors.

The preschool follows the traditional school year schedule. Days and hours of operation are Monday to Friday, 7:00AM – 5:30PM.

Facility representative stated there are no poisons kept on the premises.

Facility representative stated there are no firearms or ammunition allowed or stored on the premises.

Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible.

There is no swimming pool or other bodies of water on the premises.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in 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. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls.

LPA observed in outdoor play area next to the shed (left) a black gate door that is kept closed. LPA unhooked lock and observed the latch was loose and the nails were rusted and coming off. The gate leads into another gated area. LPA informed facility representative of the observation. Facility representative stated she noticed the same observations as LPA and stated it will get fixed.

All toilets and handwashing facilities are in safe and sanitary operating condition. Facility has one or more functioning carbon monoxide detectors. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair.

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Juvenal Moctezuma	TELEPHONE: (559) 650-7869
Pa Kou Vue	TELEPHONE: (559) 341-4624
	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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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Document Has Been Signed on 02/05/2025 12:45 PM - It Cannot Be Edited

Created By: Pa Kou Vue On 02/05/2025 at 11:54 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ST. PAULS' EVANGELICAL LUTHERAN CHURCH OF MERCED	FACILITY NUMBER: 240405513
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA records review and interview, the licensee did not comply with the section cited above in 6 of 6 staff members did not have a valid mandated reporter training ab2017 in file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/07/2025
	Plan of Correction
1 2 3 4	Facility representative stated the requested mandated reporter trainings ab1207 will be completed and copies will be sent to LPA via email by end of business on 02/07/2025.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Juvenal Moctezuma

TELEPHONE: (559) 650-7869

LICENSING EVALUATOR NAME:

Pa Kou Vue

TELEPHONE: (559) 341-4624

LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ST. PAULS' EVANGELICAL LUTHERAN CHURCH OF MERCED	FACILITY NUMBER: 240405513
	VISIT DATE: 02/05/2025

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Drinking water is available both indoors and outdoors. Drinking water is provided by personal water bottles and water dispenser and disposable cups. This facility does meals to children, snacks are provided. Food is prepared on site. Menus are posted at least one week in advance where an authorized representative can view them.

Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. LPA informed facility representative it is best practice for all staff members to become CPR and Pediatric First Aid certified.

The name of the childcare center director or fully qualified teacher(s) designated to act in the director’s absence has been reported to the Department. All children are under supervision, including visual supervision, of a teacher at all times. Facility meets teacher-child ratios. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment.

LPA reviewed a sample of staff files and observed files were not complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Upon LPA records review and interview with Facility Representative, 6 of 6 staff members did not have a valid mandated reporter ab1207 in file.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates.

LPA discussed Reporting Requirements as outlined in the regulations (Section 101212).

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Childcare Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Pa Kou Vue	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ST. PAULS' EVANGELICAL LUTHERAN CHURCH OF MERCED	FACILITY NUMBER: 240405513
	VISIT DATE: 02/05/2025

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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Childcare Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP. LPA referred facility representative to the Department website for lead: www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.

LPA discussed safe sleep regulations with facility representative and discussed the Childcare Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Pa Kou Vue	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ST. PAULS' EVANGELICAL LUTHERAN CHURCH OF MERCED	FACILITY NUMBER: 240405513
	VISIT DATE: 02/05/2025

NARRATIVE

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Exit interview conducted and report was reviewed with facility representative Melanie Sneed. Appeal rights were provided.

Per Title 22, Division 12, Chapter 1 of the California Code of Regulations, the following deficiency is being cited: (see next page).

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Pa Kou Vue	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC809 (FAS) - (06/04)

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