191602272-3-22-2023-54-CC-MAYA-CQ6TT8-20230322150018

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191602272
Report Date: 03/22/2023
Date Signed: 03/22/2023 03:01:02 PM

Document Has Been Signed on 03/22/2023 03:01 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE		FACILITY NUMBER:	191602272
ADMINISTRATOR:	VELIA GUERRA		FACILITY TYPE:	850
ADDRESS:	4645 WOODRUFF AVE		TELEPHONE:	(562) 421-8441
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90713
CAPACITY: 72	TOTAL ENROLLED CHILDREN: 10	CENSUS: 8	DATE:	03/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Director, Velia Guerra		TIME COMPLETED:	03:15 PM

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	On March 22, 2023 at 12:15 PM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Director, Velia Guerra. The purpose of the inspection was to conduct the Required 1 Year inspection at the facility. Entrance Checklist – Child Care Centers (LIC 125) was provided to the Director upon arrival. This facility is currently licensed for 72 children, ages 2 years until entry into first grade. The facility is located on St. Timothy Lutheran Church premises. There is also a licensed infant program with a toddler component located on-site (License Number: 198005392). Per Director, the preschool program operates Monday through Friday from 7:30 AM to 5:30 PM. The Director guided LPA on a tour of the inside and outside of the facility. All areas on the facility sketch were inspected. The facility currently has three (3) classrooms where care is provided. Upon arrival, the following staff were present: Staff (S1) with 3 preschool children napping in the Ladybug Classroom and Staff (S2) with five (5) preschool children napping in the Teddy Bear Classroom. The following forms were posted in a prominent, publicly accessible area at the facility: Facility License, Snack Menu, Child Passenger Restraint System Poster (PUB 269), Notification of Parents' Rights (LIC 393), Emergency Disaster Plan (LIC 610), Personal Rights (LIC 613A), Daily Activity Schedule, and Earthquake Preparedness (LIC 9148). Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Napping equipment (cots) were observed in each classroom. Per Director, bedding is taken home weekly by parents/authorized representatives to be washed.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE	FACILITY NUMBER: 191602272
	VISIT DATE: 03/22/2023

NARRATIVE

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Per Director, the isolation area is in the Director’s office. In the Director’s office, a cot can be placed on the floor for an ill child and the staff restroom is readily available if an ill child requires it. Age appropriate sinks, toilets and urinal were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed in each classroom (bottled water).

Disinfectants, cleaning solutions, and other items that are hazardous to children, were made inaccessible to children in all areas. Director confirmed that there are no poisons stored at the facility. Per Director, there are currently no children enrolled in care that require medication. First Aid supplies were observed and kept in each classroom. According to the Director, medication is only administered to a child when accompanied with a doctor's note and would be stored in a cabinet located in the classroom.

All kitchen, food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. During the inspection, snacks were reviewed for availability and quantity. Per Director, children bring lunch from home each day. All storage containers for solid waste have tight-fitting covers that are kept on and in good repair.

Smoke detector and carbon monoxide detector were tested and are operable. The facility has the required fire extinguishers fully charged and were last serviced on November 7, 2022. The facility has verification of disaster and fire drills. The last drill was conducted on December 13, 2022. LPA observed electrical outlet covers installed in all child care areas.

Outdoor playground equipment is in a safe condition, free of sharp, lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with sand that could absorb a fall. Per Director, the sand is inspected daily by staff prior to use. There is adequate shade in the outdoor play yard. No bodies of water were observed on the premises.

LPA conducted a record review of 5 children’s records and 3 personnel records for completeness. Based on the children's record review, all records have the required documents per licensing regulations. Children's roster was reviewed and is current. Sign-in and sign-out sheets were reviewed; all children present were signed in.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE	FACILITY NUMBER: 191602272
	VISIT DATE: 03/22/2023

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Based on the personnel record reviews, Staff (S1) did not have a Health Screening Report (LIC 503) and S2 did not have a current Mandated Reporter training (AB 1207) certificate of completion available for review. All staff that were present have a valid Pediatric First Aid/CPR certifications (EMSA-approved). Per Director, transportation is not provided by the facility. The names of children and staff whose records were reviewed were documented.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA advised the Director on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at: www.ccld.ca.gov.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Deficiencies were cited in accordance with Title 22 regulations (refer to deficiency page). A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Director, Velia Guerra.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/22/2023 03:01 PM - It Cannot Be Edited

Created By: Monique Ayala On 03/22/2023 at 02:33 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. TIMOTHY LUTHERAN PRESCHOOL DAY CARE	FACILITY NUMBER: 191602272
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 3 personnel records (S2) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/24/2023
	Plan of Correction
1 2 3 4	Staff (S2) will renew their Mandated Reporter training (AB 1207) and the Director will e-mail LPA proof of completion by April 24th.

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 3 personnel (S1) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/24/2023
	Plan of Correction
1 2 3 4	Staff (S1) will submit a completed Health Screening Report (LIC 503) to the facility and the Director will submit proof of completion to LPA via e-mail by April 24th.

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Monique Ayala

LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC809 (FAS) - (06/04)

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