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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500305696
Report Date: 12/13/2019
Date Signed: 12/13/2019 01:11:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GRACE LUTHERAN SCHOOLFACILITY NUMBER:
500305696
ADMINISTRATOR:GARCIA RACHELFACILITY TYPE:
850
ADDRESS:617 W.ORANGEBURG AVETELEPHONE:
(209) 522-6393
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:90CENSUS: 45DATE:
12/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rachel GarciaTIME COMPLETED:
01:45 PM
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
An unannounced Annual/Random visit #1 was conducted today by Licensing Program Analyst (LPA) Claudia Henley. LPA met with Rachel Garcia and toured the facility, both indoors and outdoors. Firearms/weapons are not allowed or stored on premises. All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than 12 children in attendance. Disinfectants, cleaning solutions and other dangerous items shall be inaccessible to children. No poisons were observed during today’s visit. All materials and surfaces accessible to children are toxic free. Medications are in a safe place inaccessible to children. All toilets, hand washing, and bathing facilities are in safe and sanitary operating conditions. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. Uncontaminated drinking water is available both indoors and outdoors. Facility has carbon monoxide detectors. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings, and slides have bark cushioning material to absorb falls. The licensee shall comply with the notice. Before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance or exemption and have been associated to the facility. Staff and children's files were reviewed. Staff are current on immunization record and mandated child abuse reporter training. The facility has an Incidental Medical Services Plan with the department. There were inhalers and Epi-pens present at the facility and are stored according to Title 22 Regulations. The child care center hours/days of operation are: Monday through Friday, 6:30 a.m. to 6:00 p.m.
Upon staff file review today, LPA observed that the Administrator of the facility (CEO) has been changed. Director Garcia was given a copy of Title 22 Regulation and all of the necessary forms that will need to be submitted to the department by January 13, 2020.

Per Title 22 Regulations, no deficiencies were cited during the visit today.
Site Visit Notice posted on the parent board. Exit interview was conducted.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019
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 1