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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830314
Report Date: 10/14/2020
Date Signed: 10/14/2020 11:46:24 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:PRINCE OF PEACE LUTHERAN PRESCHOOLFACILITY NUMBER:
334830314
ADMINISTRATOR:LILAH WHEELERFACILITY TYPE:
850
ADDRESS:701 N. SANDERSON AVENUETELEPHONE:
(951) 925-9798
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY:82CENSUS: 36DATE:
10/14/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lila WheelerTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) James Wilkerson made an unannounced phone call to PRINCE OF PEACE LUTHERAN PRESCHOOL AND KINDERGARTEN for the purpose of conducting a case management visit via video conferencing (FaceTime) regarding an incident. LPA spoke with Director, Lila Wheeler regarding an incident that took place on 09/21/20 where two children were left unattended inside a facility restroom. One teacher thought that the two children had come out of the restroom to join other children in a Bible study. The teacher was cleaning at the time. Two staff members realized that the two children were missing and not in the group they were supposed to be in. Other staff watched the children in the Bible study while the other two staff members went looking for the two children. They were found giggling inside a bathroom within a few minutes per the Unusual Incident Report. The children stated to staff that they were hiding and thought it was funny.

SEE LIC 809D for deficiency cited under Title 22 Regulations. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility for the next 12 months.This absence of supervision will result in a Civil Penalty of $500. A Civil Penalty has been assessed on this visit. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

Appeal Rights were explained and provided to Ms. Wheeler on this date. A copy of this report must be made available to the public, upon request for three years.

A return email acknowledging the receipt of this report will be used in lieu of a signature due to the COVID-19 pandemic. Due to the COVID-19 State of Emergency, this report was completed via Tele-Inspections Report Delivery Instructions. A copy of this report and form LIC 9224 (AB^33) was emailed to Ms. Wheeler on this date.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE:
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: PRINCE OF PEACE LUTHERAN PRESCHOOL
FACILITY NUMBER: 334830314
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/15/2020
Section Cited

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Responsibility for Providing Care and Supervision - (a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).
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Supervision shall include visual observation. This requirement was not met as evidenced by two children who were unaccounted for while hiding in the bathroom from staff for a few minutes according to a self reported unusual incident report.
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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: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
LIC809 (FAS) - (06/04)
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