300600390-8-16-2019-06-CC-YVIA-BF4MK3-20190816094004

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300600390
Report Date: 08/16/2019
Date Signed: 08/16/2019 09:40:09 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	GOOD SHEPHERD PRE SCHOOL		FACILITY NUMBER:	300600390
ADMINISTRATOR:	ALVAREZ-MACKOW, BERNADETTE		FACILITY TYPE:	850
ADDRESS:	7082 CRESCENT AVENUE		TELEPHONE:	(714) 827-6440
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	74	CENSUS:	DATE:	08/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	07:45 AM
MET WITH:	Bernadette Alvarez-Mackowiak, Director		TIME COMPLETED:	10:00 AM

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Licensing Program Analyst Yesenia Villa conducted an unannounced random inspection on this day to ensure the health and safety of the children in care. This Early Childhood setting is on the premises of Lutheran Church of the Good Sheperd. LPA met with Bernadette Alvarez Mackowiak, Director who guided analyst on a tour of the facility. Also present during today’s inspection was teacher Lupe Nava. All individuals present have obtained a criminal record clearance. All areas identified on the Facility Sketch were inspected. The hours of operations are from 7am-6:00pm, Monday thru Friday. This is a full day program also offering part-time hours 9am-12pm and 9am-1pm. Upon arrival, there were 4 children present with one teacher. The following was observed during the tour of the facility: Per Director, Room#1. is the only room in operation at this time due to low enrollment. Director states there are 13 students enrolled in the program. Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Linens are washed weekly by the parents. Napping equipment (cots) were observed in the classroom and were stored properly. Per Director, the isolation area is located in the office. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation of the children’s restroom was observed. Availability of indoor drinking water was observed in the classroom via a water jug. Morning and Afternoon snacks are offered, a menu was observed to be posted in a visible location. Snacks were observed to be stored in the classroom and per Director the kitchen is only used to store drinks for the children. Parents provide lunch for the children, lunch bags were observed to be labeled with the child’s name. Menus are posted one week in advance where it is visible by the child's authorized representative.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Director was reminded that all poisons must be under lock or combination.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GOOD SHEPHERD PRE SCHOOL	FACILITY NUMBER: 300600390
	VISIT DATE: 08/16/2019

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The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with sand. There is adequate shade provided by a large tree. Availability of outdoor drinking water is provided via a water jug and there was also a water fountain.There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Children’s Records were reviewed for completeness; Inspection of required forms was made. LPA issued the Children’s Record Review (LIC 811) to the Director during this inspection. In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.Staff files were reviewed for completion of immunizations, MMR, TDAP & Influenza, along with the completion of the mandated reporter training. Files were observed to be complete.

First Aid supplies were observed in the Directors office. Medication box was observed to be locked in the classroom with the appropriate authorization forms from parent.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

LPA advised the Director where to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

There were no deficiencies cited during todays inspection.

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 representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Bernadette Alvarez-Mackowiak, Director, appeal rights were issued and explained. Director was informed any appeal must be received within 15 days addressed to Regional Manager, Bertha Manzanarez.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

LIC809 (FAS) - (06/04)

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