566215900-1-24-2020-17-CC-FPEA-BL5RYY-20200124122707

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566215900
Report Date: 01/24/2020
Date Signed: 01/24/2020 12:27:13 PM

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:	TRINITY LUTHERAN PRESCHOOL		FACILITY NUMBER:	566215900
ADMINISTRATOR:	LAUNER KERRI		FACILITY TYPE:	830
ADDRESS:	2949 ALAMO STREET		TELEPHONE:	(805) 526-5975
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	10	CENSUS: 0	DATE:	01/24/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Kerri Launer		TIME COMPLETED:	10:15 AM

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	Licensing Program Analyst (LPA) Francisco Pedroza conducted an announced Pre-licensing inspection. LPA met with facility Director Kerri Launer and advised her the purpose of the inspection. LPA and Director together toured the facility inside and out. There was no children in care at the time of the inspection. The center operates from 7:00 AM to 6:00 PM, Monday thru Friday. This is a combined center with an Preschool program. The center is located on local community church with an elementary school on it's premises. A fire clearance inspection was conducted by the Ventura County Fire Department on 1/07/2020 which allows for the requested capacity of 10 children. Facility requested an infant license with a toddler option. They will be providing care from zero to 30 months old. LPA observed age appropriate toys, games, tables, chairs, and equipment available for children. The classroom had a changing table with a sink readily accessible. LPA observed four cribs available for infants to use. Facility uses cots for older infants that do not use the cribs. Food and milk will be stored in a refrigerator located in the classroom. LPA advised Director to ensure the food and milk is properly labeled for each child in care. LPA advised to ensure each child has Individual needs & services plans and feeding plans. LPA did not observe any toxins/hazardous items that would be accessible to children. The facility has an outdoor recreation yard for the children in care. Continued on 809C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020

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: TRINITY LUTHERAN PRESCHOOL	FACILITY NUMBER: 566215900
	VISIT DATE: 01/24/2020

NARRATIVE

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The recreation yard is fenced off from the facility preschool ensuring no commingling will occur. LPA observed appropriate toys and furniture available to children in care.

Classroom and Yard Measurements:
Classroom - 115.06 sqft + 149.49 sqft + 534.30 sqft = 798.85 sqft/35 (22 children)
Total classroom square footage equals 798.85 allowing enough room for 22 children.

Recreation Yard - 325.09 sqft + 55.70 sqft = 380.79 sqft/75 (5)
Total recreation yard square footage equals 380.79 allowing enough room for five (5) children.

Facility Director advised that only five children can be in the recreation yard at any given time. Director was provided a guide for Safe Sleep and effects of Lead Exposure brochures.

The facility is licensed for a capacity of 10 children effective today, January 24, 2020.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020

LIC809 (FAS) - (06/04)

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