300606458-9-11-2019-06-CC-WPOT-BFWMF9-20190911093358

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300606458
Report Date: 09/11/2019
Date Signed: 09/11/2019 09:34:12 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:	FAITH LUTHERAN CHURCH EARLY LEARNING CENTER		FACILITY NUMBER:	300606458
ADMINISTRATOR:	PAESANO, CALLIE		FACILITY TYPE:	850
ADDRESS:	8200 ELLIS AVENUE		TELEPHONE:	(714) 962-1864
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92646
CAPACITY:	53	CENSUS: 5	DATE:	09/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Callie Paesano, Director		TIME COMPLETED:	10:00 AM

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	An inspection was conducted at the facility by Licensing Program Analyst (LPA) Port. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance. Operating hours are 6:30 AM to 6:00 PM, Monday through Friday. This facility is located on the grounds of Faith Lutheran Church. Upon arrival LPA met with teacher, Jana Henke who was present with 5 preschool children in Room 1. Director, Callie Paesano entered the facility after returning from a break. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. The facility was toured inside and outside and the floor and yard plan were verified. The facility representative stated there is no bodies of water onsite. LPA confirmed with facility representative that firearms/weapons are not allowed or stored on premises. The facility appeared clean and orderly. The items which could pose a danger to children (disinfectants and cleaning solutions) were stored out of the reach of children. The director stated poisons/hazardous items are not stored on site and none were observed during today's inspection. All materials and surfaces accessible to children are toxic free. Medications are in a safe place inaccessible to children. The children’s bathrooms were observed to be in safe and sanitary operating conditions. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Food is prepared on site; snacks are provided by the facility and lunch is brought from home by each child. Food prep areas appear clean and sanitary. Food is properly stored. On site kitchen is free from hazards. Solid waste receptacles have a tight-fitting cover and are in good repair. Children nap on cots/mats, and bedding is sent home weekly to be laundered by parents. Page 1 of 3 (Continued on Page 2)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

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: FAITH LUTHERAN CHURCH EARLY LEARNING CENTER	FACILITY NUMBER: 300606458
	VISIT DATE: 09/11/2019

NARRATIVE

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There is drinking water available to children both indoors and outdoors. A current menu is posted in a prominent location viewable by an authorized representative. Menus are dated, kept on file for 30 days and viewable upon request. The facility has a working smoke detector and fire extinguisher that meet statutory requirements. During LPA's inspection LPA attempted to test the carbon monoxide detector by pressing the test button. The carbon monoxide detector did not make an audible sound. After detaching the carbon monoxide detector from the wall LPA observed the carbon monoxide detector to be without batteries. Director inserted batteries and returned the carbon monoxide detector to its designated location.

The playground was completely fenced. The playground equipment appeared in safe condition, and play area is free from hazards. There is sufficient wood bark cushioning underneath climbing structures and/or play equipment to absorb falls.

A random sample of six 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. In the areas reviewed the children’s files were found to 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. The child is signed in and out for the person responsible for the child.

Staff files for staff present during today’s inspection were reviewed for a health screening, immunization’s and mandated reporter training. At least one staff member present possesses current CPR/First Aid certifications, which expires 11/21/2019. Two files were reviewed and contained a health screening as required. Proof of immunization's against influenza (or written decline), pertussis and measles for employees present during today’s inspection were reviewed and within compliance of SB 792. Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years, per A.B. 1207. Proof of completion as required by AB 1207 was observed in staff files.
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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: FAITH LUTHERAN CHURCH EARLY LEARNING CENTER	FACILITY NUMBER: 300606458
	VISIT DATE: 09/11/2019

NARRATIVE

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This facility provides Incidental Medical Services -IMS. LPA reviewed storage of medication, 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. 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)/ (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

Facility representative was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. A copy of the Department of Social Services Lead Information brochure was given to the director.

The following violation of the California Code of Regulations, Title 22; Division 12, was observed and cited during today's inspection: Health and Safety (HSC) 1596.954 Carbon Monoxide Detector (see LIC 809D).

Exit interview was conducted with Director, Callie Paesano. Report reviewed and discussed. Notice of Site Visit was posted during the visit. 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. Appeal rights provided and explained. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Facility representative was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: FAITH LUTHERAN CHURCH EARLY LEARNING CENTER	FACILITY NUMBER: 300606458
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/12/2019 Section Cited	1 2 3 4 5 6 7	Carbon Monoxide Detector. Effective January 1, 2015, this law requires all licensed facilities and certified family homes, as specified, to have one or more carbon monoxide (CO) detectors in the facility that meet specific standards, and requires the Department to account for their presence during inspections. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on LPA's observation the sole carbon monoxide detector located in Room 2 was not operable during inspection. During examination of the carbon monoxide detectot it was determined there were no batteries in the unit. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
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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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

LIC809 (FAS) - (06/04)

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