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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360908889
Report Date: 07/10/2025
Date Signed: 07/10/2025 05:23:53 PM

Document Has Been Signed on 07/10/2025 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:FAITH LUTHERAN DAY CARE CENTERFACILITY NUMBER:
360908889
ADMINISTRATOR/
DIRECTOR:		JOY KIRBYFACILITY TYPE:
830
ADDRESS:12449 CALIFORNIA STREETTELEPHONE:
(909) 790-1816
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 18DATE:
07/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:DeDe Simpson, Interim DirectorTIME VISIT/
INSPECTION COMPLETED:
05:35 PM
NARRATIVE
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On 07/10/2025, Licensing Program Analyst (LPA) Raymond Moorehead arrived at the facility to conduct a Case Management Visit. This Case Management Visit was conducted in response to the receipt of an Unusual Incident Report (UIR) that was received on 07/01/2025, which documented an allegation of violation of Personal Rights of a child by the Subject Teacher. Please note that the UIR was self reported to the department, by the facility. LPA met with Interim Director DeDe Simpson, toured the facility, took census, and discussed the following.

The UIR reported that the Subject Teacher was heard from an adjacent room yelling at the subject child and patting the child’s back with excessive force. Several pertinent interviews stated that the loudness of the yelling and the forcefulness of the patting were audible from the next room. Interim Director stated that she intervened by entering the classroom and offering to switch places with the subject teacher to allow them to calm down.

However, it was stated that Interim Director advised the Subject Teacher that their manner of patting the child’s back was too rough and requested the teacher pat the child more gently. It was stated that the subject teacher responded that they typically pat children in that manner. When the patting continued, Interim Director stated that she returned to the classroom and instructed the subject teacher to rub the child’s back instead of patting.

Several pertinent interviews stated that there appeared to be no malicious intent by the Subject Teacher and that the teacher did not intend to harm any children. Further, the Subject Teacher denied patting the child too hard. It was also reported by the facility that the Subject Child had no visible marks or bruises related to the patting. Additional information noted that the Subject Child was crying and screaming during nap time because they did not want to stay down for nap, not as a reaction to the back patting.
NAME OF LICENSING PROGRAM MANAGER: Aaron Ross
NAME OF LICENSING PROGRAM ANALYST: Raymond Moorehead
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FAITH LUTHERAN DAY CARE CENTER
FACILITY NUMBER: 360908889
VISIT DATE: 07/10/2025
NARRATIVE
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Based on the information gathered during this visit, it was determined that Title 22 Regulation 101223(a)(2) Personal Rights was violated, which requires children to be accorded safe, healthful, and comfortable accommodations and treatment to meet their needs. This determination was made as evidenced by reports that the subject teacher was heard yelling at the child and patting the child’s back with excessive force, actions that could cause discomfort and do not meet the requirement for gentle and respectful treatment. Although the teacher denied the allegations and the interim director reported no visible marks or injuries, the repeated intervention by the interim director to change the teacher’s behavior shows that the child’s comfort and well-being were compromised.

See LIC 809-D for cited deficiency.

LPA conducted an exit interview with DeDe Simpson, Interim Director and provided a copy of this report. A Notice of Site Visit was issued and must remain posted for the next 30 days. Appeal rights were provided and discussed with Interim Director.
NAME OF LICENSING PROGRAM MANAGER: Aaron Ross
NAME OF LICENSING PROGRAM ANALYST: Raymond Moorehead
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/10/2025 05:23 PM - It Cannot Be Edited


Created By: Raymond Moorehead On 07/10/2025 at 05:10 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FAITH LUTHERAN DAY CARE CENTER
FACILITY NUMBER: 360908889

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2025
Section Cited
CCR
101223(a)(2)

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101223 (a) (2) - Personal Rights states:
To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidenced by:
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Facility agrees to conduct a staff training with all infant teachers to review appropriate methods for calming and soothing infants when they are distressed at nap time. The training will be completed by July 17, 2025.
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This requirement was not met as evidenced by reports that the subject teacher yelled at the child and patted their back with excessive force, causing the child distress. Despite no visible injuries, staff intervention to modify the teacher’s behavior indicates the child’s comfort and well-being were compromised.
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The interim director agrees to submit proof of training completion by providing a training agenda along with a sign-in sheet that includes all current infant teachers, including the subject teacher.

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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.
Aaron Ross
NAME OF LICENSING PROGRAM MANAGER:
Raymond Moorehead
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2025


LIC809 (FAS) - (06/04)
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