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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808755
Report Date: 08/25/2021
Date Signed: 08/25/2021 11:33:04 AM

Document Has Been Signed on 08/25/2021 11:33 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:LIFEHOUSE CHRISTIAN PRESCHOOLFACILITY NUMBER:
153808755
ADMINISTRATOR:CLEMENT, CINDYFACILITY TYPE:
850
ADDRESS:3311 MANOR STTELEPHONE:
(661) 588-1212
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 45TOTAL ENROLLED CHILDREN: 0CENSUS: 31DATE:
08/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cindy ClementTIME COMPLETED:
11:45 AM
NARRATIVE
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On 8/25/21 an unannounced annual inspection was conducted today by Licensing Program Analyst, (LPA) Caroline Harris. LPA met with Director, Cindy Clement and toured the facility, both indoors and outdoors. The LPA observed all required licensing forms to be posted in a visible location for authorized representatives to view them. A census was taken and there were thirty one day care children present. The facility is on the premises of Lifehouse Church. This facility runs from 7:00 AM to 6:00 PM. Morning and afternoon snacks are provided and the children bring their own lunches. Meals are eaten in the classrooms. All kitchen, food prep, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and contaminated food is discarded immediately. Solid waste storage vessels, including moveable bins, have tight-fitting covers on, are in good repair. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 (F) or less. Menus are posted at least one week in advance, where an authorized representative can view them. Firearms/weapons or ammunition are not allowed or stored on the 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. The LPA observed disinfectants, cleaning solutions and other dangerous items to be inaccessible to children. There were no poisons observed on the premises accessible to children. Licensee is aware that poisons are required to be locked and inaccessible to children. All materials and surfaces accessible to children are toxic free. 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. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. The licensee has a complete first aid kit, including bandages, scissor, thermometer, gloves and a first aid manual. Uncontaminated drinking water is available both indoors and outdoors. 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 cushioning material to absorb falls. There were no bodies of water on site.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
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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Document Has Been Signed on 08/25/2021 11:33 AM - It Cannot Be Edited


Created By: Caroline Harris On 08/25/2021 at 10:53 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: LIFEHOUSE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 153808755

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/01/2021
Section Cited
CCR
101221(a)

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Child's Records. A separate, complete and current record for each child is maintained in the child care center. This requirement was not met as evidenced by six out of ten children's files that were reviewed,
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The licensee agrees to get the required licensing forms completed and signed and get missing immunizations for the children's files listed on the LIC 811, by the due date of 9/1/21.
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were missing licensing forms or immunizations. This is a possible risk to the health, safety or personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Alice Juarez
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021


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: LIFEHOUSE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 153808755
VISIT DATE: 08/25/2021
NARRATIVE
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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. There are no excluded individuals present at this facility. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the facility and prevented from returning to the center or having contact with children in care. The licensee shall comply with the notice. Staff records contain appropriate, documentation of education credits. At least one person is to be trained in CPR and Pediatric first-aid and shall be present when children are at the facility or at off-site activities. This facility does have one person trained in CPR and first aid. Staff records contain documentation of immunizations against pertussis, measles and influenza for staff. Fire drills are conducted and documented with the date, time and how many children present, every six months. The person, who signs the child in/out, is responsible for the child, uses their full legal signature and records the time of day. Child's admission agreement is available for review.


The LPA reviewed ten children’s files. Six out of ten of the children's files had at least one incomplete licensing form or missing immunizations. Incidental Medical Services (IMS) policy was discussed. This facility does not provide Incidental Medical Services (IMS). The licensee is aware that an IMS plan is required to be submitted to the licensing office if they choose to provide any of these services. An exit interview was conducted with Cindy Clement. LPA reviewed the Mandated Child Abuse Reporter Training (AB 1207), which all staff have completed. Cindy Clement is aware that the Mandated Reporter Training is required to be updated every two years. The LPA and licensee discussed the Community Care Licensing website: www.ccld.ca.gov. which provides access to Provider Information Notifications (PINS), Quarterly Updates that inform licensees of new legislation and regulations, training's, and Licensing forms and updated information. The licensee was also advised that it is her responsibility to stay current with regulations.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are found: (see LIC809-D). A copy of this report (along with appeal rights) was provided to Cindy Clement and was reviewed. This report shall be made available to the public upon request. The LIC 9213 Notice Of Site Visit form is required to be posted for 30 days.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
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