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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334803959
Report Date: 08/24/2022
Date Signed: 08/24/2022 03:14:09 PM

Document Has Been Signed on 08/24/2022 03:14 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:TRINITY LUTHERAN CHURCH AND PRESCHOOLFACILITY NUMBER:
334803959
ADMINISTRATOR:KERRY KENNEDYFACILITY TYPE:
850
ADDRESS:30470 PAUBA ROADTELEPHONE:
(951) 676-1492
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY: 120TOTAL ENROLLED CHILDREN: 143CENSUS: 0DATE:
08/24/2022
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Kerry Kennedy, DirectorTIME COMPLETED:
03:20 PM
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On at 7:30 AM Licensing Program Analyst (LPA) Susan Brewer, arrived at the facility to conduct a 1 year required annual inspection. In addition, a case management inspection was conducted at the request of the licensee to inspect a newly constructed building A100, designated for the preschool. An application for an increase of capacity was submitted to include the changes. LPA was granted entry by Director Kerry Kennedy. LPA toured the facility, inside and out, reviewed records and observed and/or discussed the following: The licensee has designated 6 new classrooms to replace the Building 300, which will no longer be used for the preschool. During the inspection the LPA measured designated classrooms in Building 200 and the new building A100 for the requested increase of capacity.

Normal days & hours of operation have changed: Monday- Friday, 8:00 AM to 5:00 PM
The inspection consisted of reviews of the following domains: Food Service; Reporting Requirements
Physical Plant; Care and Supervision; Children Records; Staff Records; Staffing Ratio and Capacity and
Personal Rights. The inspection found the facility to be in compliance in these domains.

LPA has determined that there is sufficient space to accommodate 132 children.
Preschool Indoor Activity Areas measured on 08/24/2022 are buildings 200 and A100:
ROOMS 206, 207, 208, 209, A101, A102, A103, A104, A105 AND A106.
Total Square feet for Sanctuary…….740.00 / 35 Sq. Ft. per child = 21
(Sanctuary was previously Measured, Documented on LIC809 report dated 08/22/2008)

Preschool Bathroom Fixtures
29 Sinks x 15 ………… = 435
14 Toilets/Urinals x 15 = 210
17 drinking fountains
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2022
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: TRINITY LUTHERAN CHURCH AND PRESCHOOL
FACILITY NUMBER: 334803959
VISIT DATE: 08/24/2022
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Preschool Outdoor Activity Area:
The outdoor activity areas have sufficient space to accommodate the additional 12 children. The facility schedules outdoor activity for each classroom, using 2 separate playgrounds.

Limiting factor for preschool capacity is based on the agency’s requested capacity and fire inspection conducted by the Temecula Fire Prevention Bureau. The approval was received by the department on 08/19/2022 for 132 children. Preschool capacity is limited to 132 children.

The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days:
1. LIC 500 Personnel Report rec’d 08/24/2022.
2. LIC 610 Emergency & Disaster Plan received 08/24/2022.
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization received 08/24/2022.
5. LIC 308 Designation of Administrative Responsibility
6. LIC999 Floor Plans/Yard sketches updated and received 08/24/2022.
7. IMS Plan received on 08/24/2022;

The following items have been posted and are updated where necessary:
License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
Parent’s Rights Poster (PUB393), Personal Rights (LIC613A); Child Car Seat Law, Menu.
· The facility is operating within the terms of the license. A census was taken of 0 children present and 6 staff. The licensee stated that summer school has just ended.
· Ratios were met and appropriate supervision was provided during this inspection. Normal ratios are 15 children:2 staff per class in the 200 building and 12 children:1staff per class in the A100 building.
· Classrooms are clean, free of hazards and equipped with age appropriate furniture and equipment in good condition on 08/24/2022.
· No weapons stored at the facility 08/24/2022.
· There are no accessible bodies of water present on 08/24/2022. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: TRINITY LUTHERAN CHURCH AND PRESCHOOL
FACILITY NUMBER: 334803959
VISIT DATE: 08/24/2022
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· Medications are not stored for children at this time. If a child becomes ill the Director’s office is Room A107A is located in the A100 building and will serve as the isolation area. An isolation restroom is ATLT1, located across from the Directors Office:
· Hazards are stored where inaccessible to children which include: Disinfectants, cleaners and other items that are dangerous. Poisons and toxins are locked on 08/24/2022.
· All floors are clean and safe 08/24/2022.
· Bathrooms were observed to be safe, sanitary and in operating condition.
· Outdoor activity areas playgrounds are enclosed by appropriate fences, free of hazards and are supplied with age and size appropriate equipment in good condition on 08/24/2022.
· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin. The licensee has a monthly contract with Bug Tech.
· Measures are taken to keep the facility free of flies, other insects and rodents
· Food is stored appropriately and protected from contamination on 08/24/2022.
· Storage containers for solid waste, including moveable bins-have tight-fitting covers in good repair
· Menus are posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request.
· Uncontaminated drinking water shall be readily available both indoors and out and provided by filtered water and water bottles. If a child forgets their water bottle the facility will provide one. The facility has a total of 17 drinking fountains that are operating.
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall: Facility has sand, artificial rubber turf and artificial grass.
· Sign in/Sign out record was reviewed and meets regulation requirements on 08/24/2022.
· A Staff member is present with current Pediatric CPR/First Aid which expires on 08/2023.
· Opening and closing staff member’s CPR/First Aid expires on 08/2023.
· Director completed Health and Safety Training on 04/24/2015.
· Staff qualifications and files were reviewed and are complete on 08/24/2022.
· Staff have received on the job training for housekeeping, sanitation and universal health precautions
Licensee was informed the Department has inspection authority per Health and Safety Codes.
Licensee provided the Unusual Incident Reporting email: UnusualIncidentReportsDO10@dss.ca.gov
· Children files were reviewed and are complete on 08/24/2022.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: TRINITY LUTHERAN CHURCH AND PRESCHOOL
FACILITY NUMBER: 334803959
VISIT DATE: 08/24/2022
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· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 07/18/2022 at 9:30 AM, 19 children/5 staff present, lasted 20 minutes and evacuated to the front of the school.
· AB2370 – Lead Exposure, day care facilities, effective January 1, 2019 –
The bill requires that all Child Care Centers, operating in a building constructed before January 1, 2010, shall have their drinking water tested for excessive lead levels, on or after January 1, 2020, but no later than January 1, 2023. Child Care Centers must thereafter test their drinking water every five years after the date of the initial test.
· AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021
· AB2960 – Child care and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.

This facility provides Incidental Medical Services – IMS. LPA Susan Brewer, reviewed storage area for medication, however no medication and equipment/supplies were present at this time due to the school break. LPA reviewed children’s, personnel, and administrative records. The IMS plan was previously approved on 05/23/2016. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 For CCCs: Incidental Medical Services (IMS) policy was discussed.

The director Kerry Kennedy, was reminded that all adults 18 and over working in the facility, 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 licensed 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 Susan Brewer discussed the safe sleep regulations with Director Kerry Kennedy although the provider does not have an infant program.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: TRINITY LUTHERAN CHURCH AND PRESCHOOL
FACILITY NUMBER: 334803959
VISIT DATE: 08/24/2022
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 LPA discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Facility Representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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.

LPA Susan Brewer, reviewed with [applicant, licensee, or facility representative] the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

No corrections needed. The licensee is recommended to approve the increase of capacity for an additional 12 children and a total of 132 children.

No citations issued on 08/24/2022.

No civil penalties issued on 08/24/2022.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Facility Representative Kerry Kennedy.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC809 (FAS) - (06/04)
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