421700134-5-31-2023-17-CC-FVEZ-CSD2EV-20230531172035

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421700134
Report Date: 05/31/2023
Date Signed: 05/31/2023 05:20:41 PM

Document Has Been Signed on 05/31/2023 05:20 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	GRACE LUTHERAN PRESCHOOL		FACILITY NUMBER:	421700134
ADMINISTRATOR:	KATHY LYNN LEDOUX		FACILITY TYPE:	850
ADDRESS:	420 EAST FESLER		TELEPHONE:	(805) 922-5419
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY: 63	TOTAL ENROLLED CHILDREN: 63	CENSUS: 25	DATE:	05/31/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Crystal Corkern		TIME COMPLETED:	05:30 PM

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On 05/31/2023, at 1:30 PM Licensing Program Analysts (LPAs) Francisca Velazquez and Dixie Wright conducted an unannounced One Year Required inspection of the Child Care Center (CCC). LPAs met with Crystal Corkern, Director of the CCC and explained the purpose of the inspection. The facility is a preschool age program with three (3) classrooms and one (1) napping room. LPAs, in the company of the Director toured the interior and exterior of the CCC. The CCC operates 7:00 AM to 5:30 PM, Monday - Friday. At the time of this inspection, LPAs observed twenty-five (25) children being supervised by three (3) staff.

LPAs toured the Caterpillar classroom that offers care to children ages 2-3 years of age. LPAs observed an open face heater that is made inaccessible by means of a secured baby gate. The classroom was found to have plenty of ventilation to afford the children in care. LPAs observed age-appropriate toys and furnishings throughout the classroom. This classroom has a carbon monoxide detector that was tested at 2:20 PM and was operable during this inspection. LPAs observed cleaning compounds are stored in an elevated shelf in the classroom. LPAs toured the Ladybugs classroom that offers care to pre-kindergarten children. The classroom was found to have plenty of ventilation to afford the children in care. LPAs observed age-appropriate toys and furnishing throughout the classroom. This classroom has a carbon monoxide detector that was tested at 2:25 PM and was operable during this inspection. LPAs observed cleaning compounds are stored in an elevated shelf in the classroom. LPAs toured the Butterfly room that offers care to preschool children. The classroom was found to have plenty of ventilation to afford the children in care. LPA observed age-appropriate toys and furnishing throughout the classroom. This classroom has a carbon monoxide detector that was tested at 2:30 PM and was operable during this inspection. LPAs toured the nap room and observed all children have their assigned sleeping cot. LPAs observed teaching staffing monitoring napping children and conducting quiet activities with children that were not napping.

LPAs observed the CCC to be dusty with cluttered piles of material throughout the classrooms. In the bathroom that is used by the children, LPAs observed the sinks and toilets to have rust stains. LPAs observed two (2) toilets, three (3) urinals and three (3) sinks accessible to children in care. The CCC provides AM and PM snack, and meals are provided by individual families. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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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Document Has Been Signed on 05/31/2023 05:20 PM - It Cannot Be Edited

Created By: Francisca Velazquez On 05/31/2023 at 04:49 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GRACE LUTHERAN PRESCHOOL	FACILITY NUMBER: 421700134
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(g)

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that LPAs observed the janitor's closet wihich contain various cleaning solutions accessible to children, a broken cabinet in the outdoor playyard, broken plastic tables with sharp edges and old benches that can cause splinters which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/07/2023
	Plan of Correction
1 2 3 4	Licensee agrees to lock the gate that make the janitor's closet inacessible at all times and remove all items/furnishing that could pose a hazard to children in care by 6/7/23 and submit proof via email to Francisca.Velazquez@dss.ca.gov

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in that the licensee believes the church has tested their water source for lead containmients but is not sure nor does she have testing results which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/07/2023
	Plan of Correction
1 2 3 4	Licensee agrees to make sure CCC water source has been tested for lead containiments. If CCC has not been tested, Director agrees to test and submit results by 6/7/23 and submit proof via email to Francisca.Velazquez@dss.ca.gov

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:

Maria Mueller

LICENSING EVALUATOR NAME:

Francisca Velazquez

LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GRACE LUTHERAN PRESCHOOL	FACILITY NUMBER: 421700134
	VISIT DATE: 05/31/2023

NARRATIVE

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The CCC has an operable refrigerator. The refrigerator contains children’s dairy products. The CCC provides the children in care filtered water inside the CCC and in the outside play area by means of individual water bottles. Director reported she believes the church tested their water sources for lead containment's and does not have results. Director reported the CCC itself has not tested their water sources for lead containment's. Director does not any records documenting lead testing and results. Disinfectants and cleaning solutions stored in the classrooms are inaccessible to children in care. Extra cleaning compounds and solutions are stored in staff break room and in the janitor closet. LPAs note that during tour of the outdoor facilities the gate that makes the janitor’s closet inaccessible was not lock. In the janitor’s closet, LPAs observed bleach, soap, weed and feed, pinesol etc. Director reported there is no medication on site, however when medication is present it is stored in the classrooms in an elevated locked cabinet which are inaccessible to children in care. LPAs observed a snack menu posted as well as other licensing required notices. LPAs observed a sign- in and sign-out binder containing individual sign in sheets for each child. LPAs reviewed sign-in and sign-out binder and notes that all children present were signed in with children's arrival and departures along the authorized representative signature.

The outdoor play area is enclosed by chain link fencing. LPA observed age-appropriate toys/play equipment in the play area. LPAs observed an old hazardous cabinet that is accessible to the children in care. LPAs observed the shading mesh to be falling apart and not providing shade to the children in care. LPAs observed sheds that hold extra outdoor equipment. LPAs observed old benches that can cause splinters, old playhouse that is dirty, and old benches that are cracking and could lead to a child potential injuring themselves. Filtered water is made accessible by means of individual water bottles.

Staff and children records are reviewed. The children’s records were complete and found to contain emergency contact information as well as immunization records. Staff records were reviewed and current. Director was informed to keep training certifications current and renew certifications prior to expirations. LPAs observed the last emergency drill was conducted on 03/29/2023.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 CONT

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GRACE LUTHERAN PRESCHOOL	FACILITY NUMBER: 421700134
	VISIT DATE: 05/31/2023

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Director 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.

During today’s inspection Type B deficiencies are being cited.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Crystal Corkern.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

LIC809 (FAS) - (06/04)

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