300603211-5-17-2024-06-CC-CSUN-D5CS4H-20240517133247

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300603211
Report Date: 05/17/2024
Date Signed: 05/17/2024 01:32:52 PM

Document Has Been Signed on 05/17/2024 01:32 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	LIGHT OF CHRIST LUTHERAN PRESCHOOL		FACILITY NUMBER:	300603211
ADMINISTRATOR/ DIRECTOR:	GROBELCH, SHERYL		FACILITY TYPE:	850
ADDRESS:	18182 CULVER DRIVE		TELEPHONE:	(949) 786-3997
CITY:	IRVINE	STATE: CA	ZIP CODE:	92612
CAPACITY: 64	TOTAL ENROLLED CHILDREN: 64	CENSUS: 30	DATE:	05/17/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Director, Sheryl Grobelch		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Cyntia Sun and Licensing Program Manager (LPM) Thuy Ho conducted an unannounced case management inspection in response to a self-report Unusual Incident dated 5/14/2024. LPA met with Director, Sheryl Grobelch. Census was taken as follows: 2 staff supervising 10 preschool children in Room 1, 3 staff supervising 11 preschool children in room 2, and 2 staff supervising 9 children in room 4. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. On 5/14/24, self-reported Unusual Incident Report (UIR): C1 was dropped off by mother at around 11:20 AM. S1 delivered C1. S1 carried C1 backpack and lunch box to walk C1 to classroom. S1 opened the building door for S1 and C1 to walk in. The door closed on C1 right ring finger. C1 ring finger was jammed on the door. S1 called C1 parents. C1 father picked C1. S1 called later to check on C1. Parent said C1 had broke finger. C1 is not back to program today yet. During today's inspection, LPA interviewed S1 .S1 stated the incident happened on 5/13/24 around 11:30 AM. S1 stated the following: S1 and C1 were coming in through the back door leading to the kitchen to classroom 1. S1 was holding C1 backpack and lunch box as they entered the kitchen door. S1 was talking to C1 and did not realize C1 put right hand on the side of the door hinge. The door closed on C1 hand causing the tip of ring finger to be injured. There were no other staff or children present when incident happened. S1 immediately inform C1 parent about incident. C1 parent came to pick up C1 up around 11:40 AM.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LIGHT OF CHRIST LUTHERAN PRESCHOOL	FACILITY NUMBER: 300603211
	VISIT DATE: 05/17/2024

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On 5/15/24 S1 called C1 parent to follow-up and was informed that child received broken finger and will not be at program for the rest of the week. Director stated, after the incident happened, the following action have been implemented to prevent further accidents:
1. Teachers have been taking children to the back door and teach them not to put their hands/fingers on the doors hinges to prevent injury.
2. On 5/14/24 Director requested for maintenance to fix door hinge to make door close slower.
3. On 5/14/24 Director emailed staff to not use back door until is get fix.
4. On 5/17/24, Director emailed maintenance to follow-up to fix kitchen door hinge. Maintenance arrived during LPA visit and fixed door hinge. LPA inspected kitchen door hinge and it was fixed and confirmed by LPA to close slowly.

No deficiency was observed during today's inspection.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days. The facility representative was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The 'Notice of Site Visit' must be posted on or adjacent to the door. Failure to post Type A Reports for 30 days will result in a civil penalty of $100.00.

End of Report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC809 (FAS) - (06/04)

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