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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360910586
Report Date: 04/21/2023
Date Signed: 04/21/2023 03:46:29 PM


Document Has Been Signed on 04/21/2023 03:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:CONCORDIA CHRISTIAN SCHOOLFACILITY NUMBER:
360910586
ADMINISTRATOR:DEBORA BARAJASFACILITY TYPE:
840
ADDRESS:420 AVENUE ETELEPHONE:
(760) 256-8979
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY:30CENSUS: 5DATE:
04/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:DEBORA BARAJASTIME COMPLETED:
04:00 PM
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On April 21, 2023, Licensing Program Analyst (LPA) Babatunde Ibitoye met with Director Debora Barajas for the Required 1 Year inspection. Upon arrival, LPA toured and inspected the 1 classroom designated for School- Age children. Center also licensed for a Pre-School component (X360907170). This School-age program is held on the grounds of CONCORDIA LUTHERAN CHURCH. The hours of operation are 8:15 am to 3:30pm ,1:30 pm to 6:00 pm and 6:00Am to 6:00pm. Monday through Friday. Incidental Medical Services (IMS) were discussed.

Indoor/Children’s Area: Child care center is clean, safe, sanitary, and in good repair; all indoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard are kept free of obstruction; floors of the classroom has a surface that is safe and clean, cleaning compounds inaccessible, poisons locked, furniture/equipment is good condition, free of flies, other insects, rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has individual permanent storage space ( individually labeled with name) for his/her personal belongings.

Trash cans for solid waste have tight-fitting lids and children bring drinking water in reusable cups from home and water is also provided by the facility. All materials and surfaces are toxic free and inaccessible and there is no fireplace. There are working carbon monoxide detectors, smoke detectors, and Fire Extinguishers (3A40BC) in each classroom. There is a working land line telephone on the premises.

Restrooms: LPA inspected and observed 2 restrooms for children. Each restroom has 1 toilets and 1 sinks. LPA observed soap, toilet paper, and paper towels readily available in both restrooms. Water temperature is appropriate.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2023
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CONCORDIA CHRISTIAN SCHOOL
FACILITY NUMBER: 360910586
VISIT DATE: 04/21/2023
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Outdoor: Children’s use of the outdoor play equipment was inspected for health, safety, good repair, and age appropriateness. The area was observed to be free of debris, free from hazards, holes, broken items, and debris, No bodies of water were observed. There are areas for shade and rest.

Staff/Personnel Records: Designation of Responsibility observed, immunization's, TB clearance, mandated reporter training, health screening, criminal record statement, and a statement acknowledging suspected child abuse are available for review.

Facility Records: Roster, fire/disaster drill log last completed on 3/21/2023, CPR/First Aid and mandated report training were reviewed and maintained current.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty. The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 394L), emergency disaster plan, and earthquake preparedness checklist.

Food Service: Sharp utensils, open bottles or alcohol are inaccessible. The facility has a clean and fully stocked refrigerator/freezer. This is an after-school program and only snacks are provided.

Documents Provided and or Discussed: Forms and records to keep at the facility and IMS.

Advisory/Other: First aid supplies (thermometer, bandages,) are readily available in the classroom. There is an isolation area for children who become ill while in care located in the school’s office, the facility maintains a comfortable temperature at all times, and sign-in/out sheets are available and completed daily. Smoking is prohibited on the premises, and daily inspection for illness is conducted. Firearms/weapons are not allowed or stored on the premises. There are no pools or bodies of water on the premises.

Electrical outlets are inaccessible, there are no recalled or prohibited toys or sleep/play equipment were observed on the premises. There are no window cords accessible to children.

Continued on LIC 809-C

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CONCORDIA CHRISTIAN SCHOOL
FACILITY NUMBER: 360910586
VISIT DATE: 04/21/2023
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Sign-in and out sheets were reviewed. The parent board was reviewed and has all the required forms posted. Fire/earthquake drills current. Roster current.

Teacher- child ratios were observed and staff names were recorded. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate.

Health- Related Services: Director has been advised all prescription and non-prescription medications must have the child’s name and are dated, written consent and instruction from the child’s representative, and a plan to document and report to the child’s representative when medication is administered to a child; Medication will be properly labeled and stored in its original container. The IMS plan was discussed and Director understands when IMS is necessary

Currently, Incidental Medical Services are provided to children in care. LPA reviewed 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childquanda.html

Director advised of the requirement to report Unusual Incidents. Director was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of the daycare center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. An On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8 am-5 pm.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The director shall permit the Department to inspect the family child care home and to privately interview children or staff, to determine compliance with or to prevent violations of child care center or regulations, also enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CONCORDIA CHRISTIAN SCHOOL
FACILITY NUMBER: 360910586
VISIT DATE: 04/21/2023
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A survey will be sent to the email address provided to improve the quality and value of the new inspection process. 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, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

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. No deficiency was cited today.

An exit interview was conducted and the report was reviewed with the Director Debora Barajas

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
LIC809 (FAS) - (06/04)
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