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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503608063
Report Date: 04/22/2022
Date Signed: 04/22/2022 01:12:38 PM


Document Has Been Signed on 04/22/2022 01:12 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, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:ST. PETER LUTHERAN CHURCH & SCHOOLFACILITY NUMBER:
503608063
ADMINISTRATOR:TOEPEL, REBECCAFACILITY TYPE:
850
ADDRESS:3461 MERLE AVE.TELEPHONE:
(209) 551-4963
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:24CENSUS: 6DATE:
04/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Rebecca ToepelTIME COMPLETED:
01:30 PM
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On April 22, 2022, Licensing Program Analyst (LPA) C Brannon met with director, Rebecca Toepel. LPA took a census, toured the facility inside and outside.

The purpose of this inspection is due to preschool classroom changed from east side of the building to the west side of the building. There are two children's restroom. There are 2 toilets and 2 hand washing fixtures in the children's restrooms.

During today's inspection, LPA measured the new classroom and reviewed measurements with director, Rebecca Toepel. The approximate inside square footage is 1276, which will meets the requested capacity of 24 preschool children. During previous inspection on 2/6/18, outside measurements were taken. Approximate outside square footage is 3004, which will meet the requested capacity of 24 preschool children. There is a tree and gazebo that provides shade. Licensee is using wood chips for cushioning under the play structure.

LPA observed the following items to be addressed and corrected:
1) Shelving units are to be anchored or cannot be tipped over: shelving unit in the block area, play kitchen and play kitchen cabinet. There is a cabinet that opens and is located on the tiled area. LPA observed that the two sides that open/close are on wheels. Licensee shall ensure that this unit does not tip over. Licensee will provide pictures showing that the items were corrected.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited. Exit interview conducted and report was reviewed with director, Rebecca Toepel. This report shall be made available to the public upon request.

A 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.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022
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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