370806115-11-8-2019-20-CC-RGOU-BHQRNZ-20191108121111

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370806115
Report Date: 11/08/2019
Date Signed: 11/08/2019 12:11:16 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	CHRISTIAN CHURCH OF LEMON GROVE SCHOOL AGE PROG.		FACILITY NUMBER:	370806115
ADMINISTRATOR:	LEAVITT, LYNN		FACILITY TYPE:	840
ADDRESS:	6970 SAN MIGUEL AVE		TELEPHONE:	(619) 465-1887
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	60	CENSUS: 0	DATE:	11/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Lynn Leavitt		TIME 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	Licensing Program Analyst (LPA), Rajani Goudreau, made an unannounced visit for the purpose of a random annual inspection. Upon arrival, LPA met with Director, Lynn Leavitt and proceeded to tour the facility. There were no children in care at time of visit. Program operates: Monday through Friday from 6:30am to 6:00pm. The furniture, books, games and toys are safe, age-appropriate and in good repair. Rooms were a comfortable temperature during this visit. No hazards were noted. Medications are kept in a safe place located in Directors office, inaccessible to children. Bathrooms and hand washing areas are in a safe, sanitary and operating condition, per LPA observation. Children in care bring food from home. Facility provides am and pm snack to children. Filtered drinking water is brought to the classrooms and outside in water pitchers. All hazardous items are stored where they are inaccessible to children. The outdoor play area is fenced and has enough cushioning under and around play structures, swings and slides, per LPA observation. Play equipment has sand cushioning underneath. The disaster drill was conducted on 08/12/19. All required forms are posted in the Directors office. There is no evidence of rodent or insect activity. The carbon monoxide detector is operational. There is at least one staff present with a current CPR and First Aid certification. Sign in/out sheets and facility roster were reviewed in the classrooms and are complete. LPA observed appropriate supervision in and out of the classrooms. A sample of children's records were reviewed for admission’s agreements and staff records for qualifications. SB 792 (staff immunization's) and AB 1207 (Mandated Reporter Training) requirements have been met. Facility is reminded the Mandated Reporter Training is to be retaken every two years and can be accessed at the following website: www.mandatedreporterca.com. Isolation area is the Director's office. In addition, LPA received an updated Parent Handbook at time of visit. See LIC

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CHRISTIAN CHURCH OF LEMON GROVE SCHOOL AGE PROG.	FACILITY NUMBER: 370806115
	VISIT DATE: 11/08/2019

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPAs 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.

Director is advised to sign up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov. Select “Child Care” then “Quick Links” and Quarterly Updates. Select “Receive Important Updates” then put the email address in and choose which program(s) you would like to subscribe to and select “subscribe.”

LPAs informed Director to provide the following to Licensing by 12/31/19:

Provide an updated LIC200A- Application for a child care Center License – Original, reflecting correct licensee’s name matching with the California Secretary of State.
Provide an updated facility sketch reflecting school-age classrooms

No deficiencies cited during today’s visit. LPA conducted an exit interview with Director. LPA provided Director with the following; LIC809-LIC809D, appeal rights and LIC9213-Notice of Site Visit. LPA informed Director LIC9213 must be posted for 30 days from today’s date. LPA observed Director post notice of site visit prior to exiting facility.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019

LIC809 (FAS) - (06/04)

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