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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360908889
Report Date: 08/15/2022
Date Signed: 08/15/2022 01:18:28 PM

Document Has Been Signed on 08/15/2022 01:18 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:FAITH LUTHERAN DAY CARE CENTERFACILITY NUMBER:
360908889
ADMINISTRATOR:HEATHER URIBEFACILITY TYPE:
830
ADDRESS:12449 CALIFORNIA STREETTELEPHONE:
(909) 790-1816
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY: 7TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
08/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Director Heather UribeTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA), Samuel Lopez arrived at the facility to conduct a Case Management inspection due to the request submitted for an increase in capacity. The facility is requesting to increase the Infant Program capacity from 7 to 12. A Fire Clearance was granted on 6/28/2022.

The days and hours of operation will be Monday through Friday; 7:00 am to 5:30pm.

Previously, on 8/9/2022, LPA Lopez conducted an inspection for the requested increase of capacity however, due to the crib/napping area not being ready, measurements could not be taken.

Today, 8/15/2022, LPA Lopez toured the rooms, observed the crib/napping area, and took measurements. Based on the measurements taken, the following was determined:

Infant Indoor Activity Areas


LPA has determined that there is sufficient indoor activity space to accommodate 15 children.

Infant Bathroom Fixtures
1 toilets x 15 = 15 children
3 sinks x 15 = 45 children

Infant Outdoor Activity Area:
LPA has determined that there is sufficient outdoor activity space to accommodate 13 children.
*Waiver on file to share playground with young 2 year olds*

Limiting factor for infant capacity is the Fire Clearance granted. Infant capacity is limited to 12 children.

No citations issued during today's inspection.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2022
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FAITH LUTHERAN DAY CARE CENTER
FACILITY NUMBER: 360908889
VISIT DATE: 08/15/2022
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A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Prior to approval of the increase in capacity the following will need to be submitted/completed and approved:
1. Waiver for napping the older infants is pending approval

Exit interview conducted and report was reviewed with the Director Heather Uribe.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
LIC809 (FAS) - (06/04)
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