243808959-9-13-2023-04-CC-MDHO-CVMQWV-20230913123233

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243808959
Report Date: 09/13/2023
Date Signed: 09/13/2023 12:32:43 PM

Document Has Been Signed on 09/13/2023 12:32 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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	ST. JOHN'S LUTHERAN CHURCH PRESCHOOL		FACILITY NUMBER:	243808959
ADMINISTRATOR:	BUCHANAN, RACHEAL		FACILITY TYPE:	850
ADDRESS:	250 W ADAMS		TELEPHONE:	(209) 826-2474
CITY:	LOS BANOS	STATE: CA	ZIP CODE:	93635
CAPACITY:	12	CENSUS: 5	DATE:	09/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jamey Knorr		TIME COMPLETED:	12:45 PM

NARRATIVE

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On 09/13/23, Licensing Program Analyst (LPA) Martha De Haro, conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Director Jamey Knorr. LPA toured the facility indoors and outdoors. This facility operates on a traditional school year schedule. The preschool consists of one classroom. Hours of operation are Monday through Thursday, 8:00 am to 11:30 am. LPA confirmed the phone number to the facility as 209-826-2474. The facility does not serve meals but does serve snacks daily.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. All poisons are kept in a locked storage area. No poisons were observed during the inspection.

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. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. LPA was able to verify that fire drills are being completed at least once every 6 months.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care 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. CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE. Facility representatives indicated that they will provide attestation letter indicating that they do not use any of the facility’s water for drinking or food preparation. (Continued on LIC 809-C)

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Martha DeHaro	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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 09/13/2023 12:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: ST. JOHN'S LUTHERAN CHURCH PRESCHOOL	FACILITY NUMBER: 243808959
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. Per facility representative, the facility has not been tested for lead. Facility representative stated that the children do not drink from the drinking fountains and only drink bottled water. LPA reviewed the regulation for Lead Testing in centers opened before 2010.
	POC Due Date: 09/29/2023
	Plan of Correction
1 2 3 4	Licensee agreed to complete an attestation letter stating the following: listing the facility's water source and how often the water is brought in from the outside source, stating that the water will not be consumed (either for drinking or cooking) from the facility. Licensee agrees to also provide an updated LIC 999 facility sketch identifying all water outlets at the facility. The letter and LIC 999 to be sent to CCLD by email by the Plan of Correction due date, 09/29/2023.

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. Licensing Program Analyst (LPA) observed that the volunteer at the facility did not have any immunizations on file at the center. LPA discussed with facility representative the importance of ensuring that all staff members have a copy of their required immunizations on file at the center before being allowed to work with children, for their health and safety. Missing immunizations are Measles, Pertussis, proof of TB testing, and influenza.
	POC Due Date: 10/13/2023
	Plan of Correction
1 2 3 4	Facility representative agreed to submit proof of missing immunizations for the volunteer to the Department via email or text by the Plan of Correction due date, 10/13/23.

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: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Martha DeHaro	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ST. JOHN'S LUTHERAN CHURCH PRESCHOOL	FACILITY NUMBER: 243808959
	VISIT DATE: 09/13/2023

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The director 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 Child Care 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.

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. The name of the child care center director or fully qualified teacher(s) designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care. LPA reviewed a sample of children’s files and observed that the files were mostly complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. Child #1 and #2 were missing immunization records. LPA reviewed a sample of staff files and observed files were mostly complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Employee number #2 was missing immunization records. Menus are posted at least one week in advance where an authorized representative can view them.

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/.

Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

(Continued on LIC 809-C)

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Martha DeHaro	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ST. JOHN'S LUTHERAN CHURCH PRESCHOOL	FACILITY NUMBER: 243808959
	VISIT DATE: 09/13/2023

NARRATIVE

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The director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care 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.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies were cited during today’s inspection (see LIC 809-D).

Exit interview conducted and report was reviewed with Director Jamey Knorr.

A notice of site visit was given and must remain posted for 30 days. Appeal rights were also given.

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Martha DeHaro	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC809 (FAS) - (06/04)

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