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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561702359
Report Date: 03/09/2022
Date Signed: 03/09/2022 11:43:51 AM


Document Has Been Signed on 03/09/2022 11:43 AM - 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:CHRIST THE KING LUTHERAN PRESCHOOLFACILITY NUMBER:
561702359
ADMINISTRATOR:SARAH BRITTONFACILITY TYPE:
850
ADDRESS:3947 WEST KIMBER DRIVETELEPHONE:
(805) 499-7022
CITY:NEWBURY PARKSTATE: CAZIP CODE:
91320
CAPACITY:56CENSUS: 39DATE:
03/09/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Sarah BrittonTIME COMPLETED:
10:24 AM
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On March 9, 2022 at 9:37 AM, Licensing Program Analysts (LPA) Dean Thompson and Michael Mathews conducted an unannounced Case Management – COVID-19 inspection and met with director Sarah Britton. LPA informed the director the purpose for the inspection and completed a COVID-19 pre-screening questions prior to the commencement of the inspection. LPA was given a tour of the facility, inside and outside.

This inspection is a follow-up on COVID-19 outbreaks reported by facility staff to CCL on 1/19/2022. CCL provided a Tele - Rapid Assistance Support Team (RAST) inspection July 2020, where an LPA provided COVID-19 resources, current Childcare Industry Guidance, and a COVID-19 self-assessment guide to the facility.

LPA observed facility staff wearing masks inside the facility. Before entering the facility covid pre-screening questions were asked, sanitizer is available throughout the facility, COVID-19 safety posters were posted, .

LPA was given the facility’s COVID -19 self-assessment guide and emergency plan for when a staff member or child tests positive for COVID-19. LPA discussed COVID-19 Vaccines, Testing, Face coverings, Essential Protective Equipment and Supplies, Physical Distancing, Ventilation, Isolation for Illness, Cleaning and Disinfection, hand washing, food Service, How to Respond to Exposures or Outbreaks, and Resilience Tips during the Pandemic.

Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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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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: CHRIST THE KING LUTHERAN PRESCHOOL
FACILITY NUMBER: 561702359
VISIT DATE: 03/09/2022
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LPA reviewed that facility maintains a current Covid-19 Child Care Program Self-Assessment Guide/Mitigation plan. LPA also provided the following resources:
- Official Public Health and Child Care Guidance for COVID-19 – Updated 1/26/2022.
- COVID-19 Child Care Resources:
https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources

There were no deficiencies cited during today's inspection.

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.


Exit interview conducted and report was reviewed with director Sarah Britton.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
LIC809 (FAS) - (06/04)
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