304371036-9-6-2019-06-CC-KDEI-BFRT9H-20190906143159

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371036
Report Date: 09/06/2019
Date Signed: 09/06/2019 02:32:12 PM

COMPREHENSIVE INSPECTION

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: 7	DATE:	09/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Administrator Dilullo Cindy and Ilten S		TIME COMPLETED:	02:45 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 Analyst (LPA), Ketki Desai conducted an unannounced annual/random inspection of the facility on today's date. LPA Ketki Desai toured the facility with the director, (Dilullo Cindy and Ilten S ) inside and outside. Census was taken in individual classrooms. The overall census observed was one preschool staff and 7 napping preschool children. Between 3 classrooms (Room # 1, 2 and 3) 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. Operating hours are 7.00 and to 6.00 PM. ( Monday to Friday). During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Children bring in their own snack from home, lunch boxes are stored in their individual cubbies. The toys, floors, desks and other equipment appeared clean. There is drinking water available to children both indoors and outdoors. Most of the children do bring in their own water bottles and the water is refilled as needed. The children's bathrooms are clean and sanitary. Children with full day schedule have a specified napping schedule. Facility has conducted an emergency drill within the past six months.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

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: 09/06/2019

NARRATIVE

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The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher.
The playground was completely fenced. The playground equipment appeared in safe condition. There is enough cushioning underneath climbing structures and/or play equipment to absorb falls and has enough shade.
Facility have a Electronic Sign in/out procedure where the Parent log in / out on the I-Pad placed in each classroom.
During today's visit staffing ratios were being met. At least one staff member present possesses current CPR/First Aid certifications, which expires 8/13/2021. Children's and staff files were reviewed for compliance. Children's and staff files were in compliance.

The facility does provide Incident Medical Services. (The medications are stored in a locked cabinet in the classroom and there is also a trained EMS staff on premises who could provide the treatment but all staff have been trained to administer the treatment)
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
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.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

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: 09/06/2019

NARRATIVE

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Isolation: Director's office is used as an isolation area and additional mat and linens are available if needed.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

Facility does receive notifications for quarterly updates from Child Care Advocate program.

Provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

The facility representative 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. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182). The facility representative was informed that Licensing Updates are available at www.ccld.ca.gov

The director 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.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

LIC809 (FAS) - (06/04)

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