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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600758
Report Date: 01/17/2020
Date Signed: 01/17/2020 01:27:52 PM

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:OUR REDEEMER LUTHERAN PRESCHOOLFACILITY NUMBER:
300600758
ADMINISTRATOR:CINDY MYERSFACILITY TYPE:
850
ADDRESS:12301 MAGNOLIA AVENUETELEPHONE:
(714) 539-6643
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:72CENSUS: 27DATE:
01/17/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Teacher Charlene MenesesTIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst (LPA), Barajas, conducted an on site inspection for the purpose of an Annual Required. LPA and Facility Representative/Staff Charlene Meneses toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 3 preschool staff and 27 preschool children in rooms #3 and #4. Facility Day care hours are 7a.m-6p.m. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children locked in storage. Poisons/Hazardous Items are not kept on the premises. Snacks are provided and children bring lunch box. Food prep areas were clean and sanitary. Snacks are properly stored. Menus were posted where they could be reviewed by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by drinking fountain or cups and pitcher. The children's bathrooms are clean and sanitary. Children nap on cots/mats, and bedding is stored individually and is taken home weekly to be washed by parents at end of week. The facility has conducted an emergency drill within the past six months on 10/17/19. The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirements. The California Child Passenger Safety Law was posted by the entrance of the facility

Staff files were reviewed for staff present during the facility inspection this date. 4 out of 4 staff files were reviewed. Health screening and immunization's as required were reviewed.

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OUR REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 300600758
VISIT DATE: 01/17/2020
NARRATIVE
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Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, 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. Proof of immunization against pertussis, measles for Director and Staff were reviewed and within compliance. All Staff present provided flu/influenza written declaration letter and on file on today’s date. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. Director and all 3 Staff have not completed Mandated Reporter Training and or certificate is not on file. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications from Heart Saver, which expires 02/2021.

The facility representative Charlene Meneses was informed that the Criminal Record Statement (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. Facility Representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearances and Transfers.

Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of 8 Children's files were reviewed for documentation of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached when necessary (LIC 700) and a medical assessment LIC 701. In the areas reviewed the children’s files were found to not be in full compliance. Sign in/out procedure was reviewed for compliance. The person who signs the child in and out uses their full legal signature and records the time of the day.

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

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards.
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OUR REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 300600758
VISIT DATE: 01/17/2020
NARRATIVE
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The cushioning material sand, around the climbing equipment, swings, slides and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by working drinking fountain and water cooler, in the summer. The outdoor equipment and toys were in good repair and free of sharp edges. There was a body of water observed at the facility next to children’s playground fenced and locked, completely off limits and within compliance. The facility grounds were safe, sanitary and in good repair.

The Facility Representative was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov Facility representative, may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The Facility representative was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.
A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the Facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OUR REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 300600758
VISIT DATE: 01/17/2020
NARRATIVE
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Documents/Information to be updated and returned to the Licensing Office;
- Personnel Report (LIC 500)
- Designation of Administrative Responsibility (LIC 308)
- Administrative Organization (LIC 309)
- Fire Drill Log
- Children’s Roster (LIC 9040)

In the areas that were evaluated, Deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

Based on LPA records reviewed, 6 of 8 children, Child# 3, 4, 5, 6, 7 and Child #8 were missing on file the California School Immunization Record (CDPH 286). The following violation was observed and is being cited in accordance with California Code of Regulations, Title 22, Division 12, and Section:101220.1(g) Immunization's, is being cited on the attached LIC 809D.

Based on LPA records reviewed, 3 of 8 children, Child# 1,5 and Child# 6 were missing on file Physician Report (LIC 701). The following violation was observed is being cited in accordance with California Code of Regulations, Title 22, Division 12, and Section: 101221(b)(8) Children’s Records, is being cited on the attached LIC 809D.

Based on LPA Staff records reviewed, all 3 Staff and Director, are missing on file Mandated Reporter Training Certificate of Completion. Per Staff# 4 verbal disclosure, does not recall completing Mandated Reporter Training Online. The following violation was observed and is being cited in accordance with California Code of Regulations, Title 22, Health and Safety:1596.8662(b)(1), Mandated Reporter Training, is being cited on the attached LIC 809D.
An exit interview was completed with Facility Representative: Charlene Meneses. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OUR REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 300600758
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2020
Section Cited

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Immunizations 101220.1(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement was not met as evidenced by:
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Based on LPA Children's Records reviewed, 6 of 8 children, Child# 3, 4, 5, 6, 7 and Child #8 were missing on file the California School Immunization Record (CDPH 286). This poses a potential risk to the health and safety of children in care.
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Type B
01/24/2020
Section Cited

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101221(b)(8) Child’s Records. The child’s record shall contain their medical assessment including specified information. This requirement is not met as evidenced by:
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Based on LPA Children's Records reviewed, 3 of 8 children, Child# 1,5 and Child# 6 were missing on file Physician Report (LIC 701) on file. This poses a potential immediate risk to 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: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2020
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OUR REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 300600758
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2020
Section Cited

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1596.8662(b) (1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by:
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Based on LPA, 4 Staff records reviewed, all 3 Staff and Director are missing on file Mandated Reporter Training Certificate of Completion. Per Staff# 4 verbal disclosure, does not recall completing Mandated Reporter Training Online. This poses a potential immediate threat to 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: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2020
LIC809 (FAS) - (06/04)
Page: 6 of 6