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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601364
Report Date: 09/12/2023
Date Signed: 09/12/2023 03:17:17 PM

Document Has Been Signed on 09/12/2023 03:17 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ASCENSION LUTHERAN PRESCHOOL & CHILD CARE CENTERFACILITY NUMBER:
191601364
ADMINISTRATOR:BRIANA MINTON-JENSENFACILITY TYPE:
850
ADDRESS:17910 S. PRAIRIE AVETELEPHONE:
(310) 214-3905
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 24DATE:
09/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:BRIANA MINTON-JENSEN, DirectorTIME COMPLETED:
03:36 PM
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On 09/12/2023, Licensing Program Analyst (LPA) Cohen made an unannounced visit and met with Briana Minton-Jensen, preschool director for the purpose of conducting a follow up Case Management - Incident investigation. The facility had self reported a lack of supervision to a three-year-old child (C1) who walked out of the facility building during a restroom break. The child walked off the premises through a gate to Prairie Avenue and 178th Street, which is ½ block off the preschool. According to the Torrance Police Officer, the child was found by three neighbors who called the Torrance Police Department. The child was returned to the preschool by two police officers. The parent was contacted by the preschool director and met with the police officer. On the day of the incident, there were five staff members present caring for 22 children.
The facility contacted the Regional Office within 24 hours and submitted the written report within 7 days.
Upon arrival, the director and LPA toured the playground where the incident occurred. During today’s visit, LPA obtained copies of the Emergency ID Form (C1), Teacher’s attendance.
According to the director, the following changes were implemented the day after incident occurred, 08/29/2023:
1. Two gates located in the grass area facing Prairie Avenue were secured and locked with shorten chains to prevent opening.
2. New procedures implemented for staff members
a) Double check all gates for security
b) Classroom count for children to be posted on the classroom doors; count children during transitions (beginning and ending)
c) CCL Safety Training Videos viewed (attendance with signature and written declaration obtained)
d) Director met with church office and discussed security measures for two additional gates and secured keypads for existing gates
e) Director requested church office to send an email to Korean church (leasing from Lutheran church) to remind members to keep all gates closed and secured during preschool business hour
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ASCENSION LUTHERAN PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 191601364
VISIT DATE: 09/12/2023
NARRATIVE
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Based on the investigation, including interviews (written declaration obtained) with relevant parties, observations by the LPA, and consultation with management, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. SUBSTANTIATED- A finding that a complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.
The facility was cited a Type A deficiency according to California Code of Regulations Title 22 (See LIC 9099D report for deficiencies). Licensee is to post notice of Site Visit for 30 Days, failure to do so will result in $100 immediate civil penalty. This report must be copied and given to all parents and to the parents of any child enrolling within the next 12 months. A copy of Lic 9224 must be signed and retained in the file.
A plan of correction was discussed with the director. An exit interview and a copy of this report along with Appeal Rights were explained and provided to Briana Minton-Jensen.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
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Document Has Been Signed on 09/12/2023 03:17 PM - It Cannot Be Edited


Created By: Miriam Cohen On 09/12/2023 at 02:37 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ASCENSION LUTHERAN PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 191601364

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/28/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision - The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time...
This requirement was not met as evidenced
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*Director agrees to provide a written statement (LIC 855/Declaration Form) on intention to keep children safe at all times.
Declaration to be submitted to LPA by 09/15/2023, end of business day. of business day.
*Construction of two additional gates and
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 by Child #1(C1) found wandering outside of the facility. Director admitted that C1 was found outside facility and returned by police officers. This poses an immediate risk to the health, safety, or personal rights of children in care.
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secured keypads for existing gates to be completed on 09/28/2023. Photos of additional gates and key pads to be submitted to LPA by 09/28/2023.
*Director agrees provide an in-service to all staff members to include watching the following CCL videos:
https://ccld.childcarevideos.org/child-care-center-operators/supervising-children-in-child-care-centers/
https://ccld.childcarevideos.org/child-care-center-operators/childrens-personal-rights-in-child-care/
*Director agrees to provide a written statement of completion, using LIC 855 (Declaration Form), from all staff members. Declaration to be sent to LPA, via email, by 09/15/2023, end of business day.


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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:Maureen Neal
LICENSING EVALUATOR NAME:Miriam Cohen
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023


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