<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614141
Report Date: 04/04/2023
Date Signed: 04/04/2023 11:09:11 AM


Document Has Been Signed on 04/04/2023 11:09 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:FAITH LUTHERAN PRESCHOOLFACILITY NUMBER:
343614141
ADMINISTRATOR:MANGES, LISAFACILITY TYPE:
850
ADDRESS:4000 SAN JUAN AVETELEPHONE:
(916) 961-6069
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:45CENSUS: 29DATE:
04/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lisa MangesTIME COMPLETED:
11:30 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
All times on this report are approximations. At 8:30 a.m. on Tuesday, April 4, 2023, Licensing Program Analyst (LPA) Michelle Pascual met with Director, Lisa Manges, for the purpose of an unannounced 1 year required inspection. Director guided LPA on a tour of the facility, at which time a census of 28 preschool children supervised by four (4) staff and were observed in three classrooms, Frogs, Duck & Fish & Froglets. All individuals subject to criminal background review have obtained criminal record clearance. The hours of operations is 7:30 am- 5:30 pm Monday thru Friday.

A health and safety inspection was conducted in the classrooms, restrooms, food service areas, and outdoor play areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster and daily schedule. The menus were posted for the snacks being provided. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Medications are stored, inaccessible to children. Director stated there are no poisons on the premises. Furniture and equipment are in good condition, and toileting facilities are in sanitary, and operating condition. Bins for solid waste in the kitchen have tight fitting lids. The floors appeared clean throughout the facility. The program has parents provide one snack and lunch. The facility provides one afternoon snack.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: FAITH LUTHERAN PRESCHOOL
FACILITY NUMBER: 343614141
VISIT DATE: 04/04/2023
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
26
27
28
29
30
31
32
LPA reviewed children's records. Each child's file contained an emergency card, consent for emergency medical treatment, health history and notifications of children’s and parent’s rights. LPA reviewed staff records and reminded Director to update Mandatory Reporter for all staff every two-years. Two Mandatory Reporter training's were expired.

CPR is current for all staff, expiring in 08/2024.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s personnel, and administrative records. LPA reminded the director to audit medication to confirm that all medication are current. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Center Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 513-0301 (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.ht



LPA discussed Assembly Bill 2370, which will require licensed Child Care facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1st, 2020 to January 1st, 2023 and must be conducted every five years from initial testings. Results must be submitted to the Regional office.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: FAITH LUTHERAN PRESCHOOL
FACILITY NUMBER: 343614141
VISIT DATE: 04/04/2023
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
26
27
28
29
30
31
32
Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

Exit interview conducted and report was reviewed with the licensee Lisa Manges. A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods,
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3