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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597634
Report Date: 05/20/2024
Date Signed: 05/20/2024 05:23:44 PM


Document Has Been Signed on 05/20/2024 05:23 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:HOPE LUTHERAN PRESCHOOLFACILITY NUMBER:
191597634
ADMINISTRATOR:HEAD, ELLENFACILITY TYPE:
850
ADDRESS:1041 E. FOOTHILL BLVD.TELEPHONE:
(626) 335-5315
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:48CENSUS: 30DATE:
05/20/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Ellen Head - DirectorTIME COMPLETED:
05:35 PM
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Licensing Program Analysts (LPA) Cynthia Reyes conducted an announced plan of correction (POC) inspection on this date for the purpose of inspecting the facility to ensure the health and safety standards as required by the regulations governing childcare centers are met. Upon arrival LPA met with Director, Ellen Head and the nature of the inspection was discussed.

LPA requested proof of all POC from 05/08/2024 that were due 05/10/2024. Director stated she had emailed the corrections to LPA Reyes on 05/10/2024. LPA informed Ellen that no Email or mailed copies were ever received. Director Ellen handed LPA the updated and complete staff personnel Report and the Children's Roster. As for the Sign In and Sign Out correction, Ellen gave LPA a copy of a reminder document to sign the children in/out that she stated she gave the parents, however there is no date, signature from her or list of the parents who receive this notice. Ellen also did not provide the rest of the POC for this citation of a written statement by her of what steps she will take to ensure parents are signing in/out. Facility was also cited for Limitations on Capacity and Ambulatory Status, for an infant that had been enrolled and in care and commingling with preschool children. Directors POC was to submit to the department in writing the steps she will take to ensure children are not commingled at the facility and the steps she will take to ensure the enrollment process is completed correctly. As of this date these corrections have not been made.

Director also had an office meeting with the department on 04/09/2024 and has not made the corrections she agreed to as of this date.

Continue on next page.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HOPE LUTHERAN PRESCHOOL
FACILITY NUMBER: 191597634
VISIT DATE: 05/20/2024
NARRATIVE
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On 05/08/2024 LPA made an inspection for the purpose of an immediate Exclusion letter she received on April 29, 2024. The letter instructed the Director to ensure Sherry Keller is disassociated and not working at the facility. As of this date Director Head has not disassociated the individual. LPA instructed the Director Head to disassociated her at this time. Director handed the LPA a copy of a letter of Termination of 04/29/2024 for Sherry Keller from the facility dated 05/08/2024 with her signature and board member Bryan Brophy signature. Director stated on this date she is having trouble with guardian to disassociate Sherry Keller and will submit the disassociation by 9 AM tomorrow morning (05/21/2024).

LPA reviewed children's files and only 18 out of the 43 children enrolled have a copy of the LIC 9224 in their file for the Type A citation dated 05/08/2024. Director stated some children have not been at school and she likes to hand the parents in person a copy of the license report and Acknowledgement of Receipt of Licensing Reports Form

At this time, the licensee is not in compliance in the preschool program with California Code of Regulations Title 22. See Deficiencies Re-cited on the 809D page

Type A - A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form LIC9224 during this visit.

The Notice of Site Visit (LIC 9213) 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 the Director, Ellen Head.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/20/2024 05:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: HOPE LUTHERAN PRESCHOOL
FACILITY NUMBER: 191597634

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/20/2024
Section Cited
CCR
101161(A)

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RE-CITATION: Limitations on Capacity and Ambulatory Status. The licensee shall not exceed the conditions, limitations and capacity specified in the license. Based on interview and LPA observation of documents, an infant had been enrolled and in care and commingling with preschool
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Director states with submit to the department in writing the department will take to ensure children are not commingled at the facility and the step she will take to ensue the enrollment process is completed correctly to ensure the chid is the correct age when the child starts in the licensed preschool. Send POC by 5/24/24
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children for about a month before he turned 2 years old. This poses an immediate health and safety risk to the 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 05/20/2024 05:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: HOPE LUTHERAN PRESCHOOL
FACILITY NUMBER: 191597634

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2024
Section Cited
CCR
101229.1(b)

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RE-CITATION: Sign In and Sign Out (b) The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement is not met as evidenced by: Based on LPA observation, the licensee did not comply with the section cited above. There were 40 children in care
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Director states, will remind all parents to sign there child in/out, and will send a notification to all parents. Director will submit a written statement to the LPA by 5/24/24 of what was sent to parents/guardians and what steps she will take to ensure all parents/guardians are reminded to sign their child in/out.
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and 4 were not signed in, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
05/24/2024
Section Cited
HSC1596.8595(c)

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A licensed child care home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision
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Director signed a declaration stating that all currently enrolled children as well as all incoming children from 05/08/2024 till next year 05/08/2025 will have the LIC 9224 signed and dated and placed in their child's file and director will provide LPA with proof of all parents who received and signed the
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(a) of Section 1596.893b. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in 25 out of 43 childrens files did not have LIC 9224, which poses/posed a potential health, safety or personal rights risk to persons in care.
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LIC9224 forms for their child. Submit a signed document by all parents who recived and signed the LIC 9224 by the POC date of 5/24/2024.
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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4