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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503605107
Report Date: 05/21/2019
Date Signed: 05/21/2019 11:52:43 AM

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:EMANUEL LUTHERAN DAY CAREFACILITY NUMBER:
503605107
ADMINISTRATOR:LAURA MARQUEZFACILITY TYPE:
830
ADDRESS:324 COLLEGE AVE.TELEPHONE:
(209) 523-4531
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:20CENSUS: 14DATE:
05/21/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Laura Marquez - DirectorTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs) Joseph Pacheco and Luisa Gavoutian conducted an unannounced plan of correction inspection. LPAs met with Director, Laura Marquez and took a census. The purpose of today's inspection was to clear deficiencies that were sited during the annual/random inspection on 4/23/19.

On 4/23/19 facility was cited a Type B deficiency for regulation 101417(a)(1) - The infant care center shall obtain written permission from the child's authorized representative for the placement of the child in the toddler program. Based on nine records reviewed, Licensee failed to obtain written permission from the nine children's authorized representatives for the placement of the children in the toddler program. Today LPAs observed written permission from authorized representatives to be placed in toddler program in children's files.

On 4/23/19 facility was cited a Type B deficiency for regulation 101417(a) - Licensees serving infants may create a special program component for children who are between 18 months and 36 months. Based on observation, interview, and records review, three children were enrolled into the toddler component who were under the age of 18 months. Today LPAs reviewed a revised Plan of Operation indicating toddler component is for children 18 to 36 months of age.

On 4/23/19 facility was cited a Type B deficiency for regulation 101223(a)(2) - (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. Based on observation, one infant was asleep in a baby swing instead of a crib. Today LPAs observed sign-in sheets of staff that were provided training on safe sleep practices and submitted written statement on safe sleep procedures.

CONTINUED ON 809-C
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: EMANUEL LUTHERAN DAY CARE
FACILITY NUMBER: 503605107
VISIT DATE: 05/21/2019
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All deficiencies cited on 4/23/19 have been cleared during today's inspection.

No deficiencies cited in the areas inspected today. Exit interview conducted with Director, Laura Marquez.

This report must be available to the public upon request. LIC 9213 Notice of Site Visit form to be posted for 30 days.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
LIC809 (FAS) - (06/04)
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