304371036-6-10-2019-06-CC-STOE-BCZNDZ-20190610102310

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371036
Report Date: 06/10/2019
Date Signed: 06/10/2019 10:23:18 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:	CHRIST LUTHERAN CHURCH- PRESCHOOL		FACILITY NUMBER:	304371036
ADMINISTRATOR:	DILULLO, C. & ILTEN, S.		FACILITY TYPE:	850
ADDRESS:	820 W. IMPERIAL HWY		TELEPHONE:	(714) 529-0892
CITY:	BREA	STATE: CA	ZIP CODE:	92821
CAPACITY:	44	CENSUS: 10	DATE:	06/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:24 AM
MET WITH:	Cindy Dilullo and Susan Ilten		TIME COMPLETED:	10:30 AM

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An unannounced visit was conducted by the Licensing Program Analyst (LPA) Torrence on 06/10/2019 at 8:24 a.m. During the visit, LPA met with Co- Directors Cindy Dilullo and Susan Ilten, who guided analyst on a tour of the facility inside and out. Census was taken. There was a total of 10 children present. LPA observed 10 children in Room #1 and one staff supervising. At this time, the preschool is operating its summer program. Operation hours are 7:00 a.m. to 6:00 p.m. Monday to Friday. During this visit, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratio. 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.

The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Equipment and furniture were inspected to ensure it's in good condition, free of sharp, loose or pointed parts. Toilets and sinks were inspected to ensure they are safe and in a sanitary operating condition, floors were inspected for safety and cleanliness. This facility provide lunch through an outside vendor or parents provide lunch for their child. Snack is provided by parents on a rotating basis. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material. Staff's files were reviewed for education verification, CPR/First Aid, and new immunization requirements for (MMR, Pertussis, and Flu vaccines). Facility has a current disaster drill log. Fire extinguisher and carbon monoxide was located at this facility. A sample of children's files were reviewed for completeness of admission agreement, verification of sign in/out including time the child was signed in/out by authorized representative as well as verification of representative’s full legal signature. This facility utilize an electronic sign in/out process.

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019

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: CHRIST LUTHERAN CHURCH- PRESCHOOL	FACILITY NUMBER: 304371036
	VISIT DATE: 06/10/2019

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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.htmThe updated plan of operation has been received in our office for providing Incidental Medical Services. (IMS).

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov . Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov

During this inspection, there was no deficiency cited per CA Code of Regulations Title 22.

Exit interview was conducted. Report reviewed and discussed. 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. Notice of Site Visit was posted during the visit. Appeal rights provided and explained. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

END OF REPORT

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019

LIC809 (FAS) - (06/04)

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