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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360908889
Report Date: 10/04/2022
Date Signed: 10/04/2022 12:38:42 PM

Document Has Been Signed on 10/04/2022 12:38 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: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
10/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Director, Heather UribeTIME COMPLETED:
12:45 PM
NARRATIVE
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On 10/04/2022, Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility to conduct a case management inspection regarding elevated level of lead in the One Year Old Classroom sink. During this inspection, LPA Hogue toured the facility, inside and out, took census, verified facility associations, reviewed records, and discussed the following with Director, Heather Uribe:

LPA Hogue toured the One Year Old Classroom, specifically the water faucet located in the classroom. LPA Hogue observed the classroom sink to have a hand washing and drinking spout, along with both spouts dispersing water.

Per Director, the facility supplies bottled water which is stored in the kitchen, and water jugs are located in each classroom. Each child has their own personalized water bottle that is located in the classroom and refilled with water from the water jug. Per Director, there is a staff member who is responsible for refilling the water jugs throughout the day. Per Director, the facility has never utilized the drinking faucets located throughout the facility, as a source of water for children. Also, Director disclosed, the sink in the One Year Old classroom is not used for food preparation.

See LIC809-D for cited deficiencies.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director, Heather Uribe.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2022
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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Document Has Been Signed on 10/04/2022 12:38 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Destinee Hogue On 10/04/2022 at 12:05 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: 10/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
10/04/2022
Section Cited
CCR
101238(a)

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Building Grounds. (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.



This requirement is not met as evidenced by:
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During this inspection, Director made the drinking faucet of the sink inaccessible to children by placing an "Out of Service, Do Not Use for Drinking!" sign on the sink, along with placing tape around the drinking spout. Also, on October 15, 2022, the sink in the One Year Old classroom is scheduled to be replaced.
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Based on records review and observation, the sink in the One Year Old classroom has tested with a lead exceedance higher than 5 ppb. According to Director, the sink in the classroom is only used for handwashing, and water jugs and personalized water bottles are available in each classroom which poses a potential health, safety, and personal rights risk.
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During this inspection, LPA Hogue received a copy of service invoice for faucet/sink replacement. Director agrees to submit pictures, once the new faucet/sink is installed. Deficiency cleared during this inspection.

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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:Kimberly Williams
LICENSING EVALUATOR NAME:Destinee Hogue
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022


LIC809 (FAS) - (06/04)
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