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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360910037
Report Date: 07/01/2026
Date Signed: 07/01/2026 04:29:36 PM

Document Has Been Signed on 07/01/2026 04:29 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:REDEEMER LUTHERAN PRESCHOOLFACILITY NUMBER:
360910037
ADMINISTRATOR/
DIRECTOR:		AMBER WATSONFACILITY TYPE:
850
ADDRESS:920 W. 6TH STREETTELEPHONE:
(909) 986-6510
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 66TOTAL ENROLLED CHILDREN: 16CENSUS: 10DATE:
07/01/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Mary Pauge TIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA), Aman Lama arrived at the center to conduct an annual inspection. LPA met with the facility representative, Mary Pauge. The center is currently only operating out of classrooms D and E, which were both inspected on this date. LPA toured indoor and outdoor areas, and the following was observed and/or noted:
The inspection consisted of reviews of the CARE tool domains. The inspection found the facility to be in compliance, except as noted on the LIC809D. Deficiencies were cited this visit.

The following documents are requested to be updated if any changes made, and submit to the Riverside Regional Office (RRO) within 30 days of this report:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility

The following items have been requested to be posted in prominent locations where necessary:
- License
- Emergency Disaster Plan (LIC610), facility sketch and Earthquake Preparedness Checklist (LIC9148)
- Parent’s Rights Poster (PUB393)
- Personal Rights (LIC613A)
- Child Car Seat Law
- Food menu.
NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena
NAME OF LICENSING PROGRAM ANALYST: Aman Lama
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2026
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 17
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: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 360910037
VISIT DATE: 07/01/2026
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·The facility is operating within the limits as stated on the license.
· Ratios were met during this inspection with appropriate supervision.
· Classrooms are adequately equipped with age and size appropriate furniture and free of hazards.
· There are no weapons present at the facility.
· No accessible bodies of water were observed by LPA at the time of this inspection. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Children bring their own water bottles/cups from home. In the event that a child needs water, LPA observed large gallons of water dispensers with disposable cups inside the classrooms.
· Hazards are stored where they were inaccessible to children. These include: Disinfectants, cleaning solutions and other items that are dangerous to the health and safety of children in care.
· Poisons and toxins are to be kept locked and were observed inaccessible, per Title 22 Regulations. Facility representative placed chemicals that are considered poisonous from classroom D, behind a key lock during todays inspection.
· All floors were observed clean, safe, and shall remain so at all times.
· Restrooms were observed to be sanitary and in operating condition.
· Playgrounds are enclosed by appropriate fences.
· Outdoor activity areas are in good condition and supplied with age/size appropriate equipment.
· High climbing equipment, swings, slides/similar equipment were cushioned with material to absorb falls.
· Children bring their own food from home. Occasionally, the center offers a "hot lunch" as an option to purchase. Food preparation areas for these occasions is clean, free of litter, vermin and food is stored appropriately and protected from contamination.
· Storage containers for solid waste, including moveable bins required to have tight-fitting covers were observed on and in good repair.
· Sign in/Sign out record was reviewed and meets regulation requirements.
· Upon record review, LPA did not find any staff present with a current CPR/First Aid on file.
· A review of children’s records were found to be complete during this inspection, except as noted on the LIC809D.
· Disaster drills are to be conducted every six months – documentation of drills were unavailable.
· The facility is informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena
NAME OF LICENSING PROGRAM ANALYST: Aman Lama
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026
LIC809 (FAS) - (06/04)
Page: 3 of 17
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: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 360910037
VISIT DATE: 07/01/2026
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·The facility can submit transfer forms to associate or disassociate someone from their facility at: Associations_Disassociations862@dss.ca.gov
· A review of staff records indicates that staff that were present meet minimum qualifications for the position for which they were hired. Staff records were complete.

- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Alternate training's are also available online on our website: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/resources-for-providers/training-and-educational-resources

AB2960 – Childcare 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 childcare and development services online portal for families and providers by June 30, 2022.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

• CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES, Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code section 1597.16.
NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena
NAME OF LICENSING PROGRAM ANALYST: Aman Lama
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026
LIC809 (FAS) - (06/04)
Page: 4 of 17
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: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 360910037
VISIT DATE: 07/01/2026
NARRATIVE
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For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP.).
LPA verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP. LPA referred licensee to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.
During the exit interview, the Licensee [name], confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

- LPA also informed licensee of the importance of checking for recalled infant/child devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant/child devices with the CPSC to be notified of any recalls on their purchased equipment.
LPA Aman Lama informed facility representative, Mary Pauge that this report dated July 1, 2026 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Aman Lama informed the facility representative to provide a copy of this licensing report dated July 1, 2026 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing
NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena
NAME OF LICENSING PROGRAM ANALYST: Aman Lama
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026
LIC809 (FAS) - (06/04)
Page: 5 of 17
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: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 360910037
VISIT DATE: 07/01/2026
NARRATIVE
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Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to facility representative, Mary Pauge.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Mary Pauge.

NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena
NAME OF LICENSING PROGRAM ANALYST: Aman Lama
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026
LIC809 (FAS) - (06/04)
Page: 6 of 17
Document Has Been Signed on 07/01/2026 04:29 PM - It Cannot Be Edited


Created By: Aman Lama On 07/01/2026 at 03:18 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: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 360910037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

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. Upon LPAs review, 1 out of 3 staff present were not on the facility roster. S2 did not have documentation of a fingerprint clearance request on file. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/02/2026
Plan of Correction
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Facility representative agrees to obtain proof of fingerprint clearance for S2 and submit to the department no later than the POC due date. The facility is responsible to ensure all staff/volunteers are fingerprint cleared and on the facility's roster.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2026


LIC809 (FAS) - (06/04)
Page: 7 of 17
Document Has Been Signed on 07/01/2026 04:29 PM - It Cannot Be Edited


Created By: Aman Lama On 07/01/2026 at 03:18 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: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 360910037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101160(a)
Posting of License
(a) The license shall be posted in a prominent, publicly accessible location in the center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation of postings, the licensee did not comply with the section cited above. The center is advised to keep license in a prominent, publicly accessible location in the center. Upon staffs admission, parents do not sign their children in or out inside the classroom, rather outside of the classroom below a bulletin board. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2026
Plan of Correction
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Facility representative agrees to submit proof of postings in a prominent, public area.
Type B
Section Cited
CCR
101174(d)(2)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months. (2) The drills shall be documented. This documentation shall be kept in the child care center for at least one year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on facility representative's own admission, the licensee did not comply with the section cited above. Facility representative could not produce proof of documented disaster drills during todays inspection. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/06/2026
Plan of Correction
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Facility representative agrees to conduct a disaster drill with the children and create proof of documented log. LPA will return at a later time to clear the citation.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2026


LIC809 (FAS) - (06/04)
Page: 8 of 17
Document Has Been Signed on 07/01/2026 04:29 PM - It Cannot Be Edited


Created By: Aman Lama On 07/01/2026 at 03:18 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: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 360910037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101218.1(c)
Admission Procedures and Parental and Authorized Representative's Rights
(c) The licensee shall post the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster in a prominent, publicly accessible area in the child care center at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
The center is advised to keep the PUB292, Child Care Center Notification of Parents' Rights Poster in a prominent, publicly accessible area in the center at all times. Currently, the postings (including the license, parents rights poster, child care seat law and Children's rights poster) are in the classroom and 'directors office'. However, parents do not enter these areas on a daily basis, rather they sign in outside of the classrooms. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2026
Plan of Correction
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2
3
4
Facility representative agrees to submit proof of postings in a prominent, public area.
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. 1 out of 3 staff files did not have proof of Mandated Reporter Training (MRT) on file. S3 did not have MRT on file for review. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
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2
3
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Facility representative agrees to collect a file for S3, including proof of MRT specifically in "Child Care Providers". The training can be found online at: mandatedreporterca.com
LPA will return at a later time to clear the citation.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2026


LIC809 (FAS) - (06/04)
Page: 9 of 17
Document Has Been Signed on 07/01/2026 04:29 PM - It Cannot Be Edited


Created By: Aman Lama On 07/01/2026 at 03:18 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: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 360910037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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. 2 out of 3 staff present did not have proof of immunizations nor flu declinations on file. Upon review of S2 and S3s files, there were no proof of immunity to Measles (MMR), pertussis (Tdap) nor record of flu shot or written declination. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
1
2
3
4
Facility representative agrees to obtain proof of immunizations for MMR, Tdap and Flu shot OR written declination to the flu shot for S2 and S3, and place in their respective files. LPA will return at a later date to clear this citation.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

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. 3 out of 3 staff files did not contain updated CPR/First Aid certificates that are EMSA (Emergency Medical Services Authority) approved. S1's certificate was expired, S2's certificate is not EMSA approved, and S3 did not have a file to review. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
1
2
3
4
Immediately, facility representative agrees to enroll at least one staff who is present every day during AM and PM sessions and submit proof of enrollment to licensing, no later than the POC due date. Once the certificate is granted, facility representative understands to place in the staff's file for review from licensing at a later time.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/01/2026 04:29 PM - It Cannot Be Edited


Created By: Aman Lama On 07/01/2026 at 03:18 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: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 360910037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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. S2 and S3 did not have proof of a health screening (LIC503 or similar) on file for LPAs review. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
1
2
3
4
Facility representative agrees to obtain proof of LIC503 for S2 and S3, and place in their respective files. LPA will return on a later date to clear this citation.
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and facility representatives' own admission, the licensee did not comply with the section cited above. The facility/licensee did not ensure personnel records are maintained on each employee. S2 did not have a complete file to review, and S3 did not have a file to review at all. Additionally, the LIC309 needs to be updated and submitted. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
1
2
3
4
The facility is asked to obtain files for S2 and S3, as well as update the LIC309. LPA will return on a later date to clear this citation.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2026


LIC809 (FAS) - (06/04)
Page: 11 of 17
Document Has Been Signed on 07/01/2026 04:29 PM - It Cannot Be Edited


Created By: Aman Lama On 07/01/2026 at 03:18 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: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 360910037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)(12)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g).

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. S3 did not have proof of a (Tuberculosis) TB clearance on file. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
1
2
3
4
Facility agrees to obtain proof of TB clearance for S3 and place in her file. LPA will return on a later date to clear this citation.
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on facility representatives' own admission, the licensee did not comply with the section cited above. A completed file for S2 was unavailable, and there was no file available for S3. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
1
2
3
4
Documentation must be maintained at the child care center and shall be available to the licensing agency for review. LPA will return at a later date to clear this citation.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2026


LIC809 (FAS) - (06/04)
Page: 12 of 17
Document Has Been Signed on 07/01/2026 04:29 PM - It Cannot Be Edited


Created By: Aman Lama On 07/01/2026 at 03:18 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: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 360910037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

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. C3's file did not have the LIC627 signed off by an authorized representative. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2026
Plan of Correction
1
2
3
4
Facility representative agrees to obtain a signature on the LIC627 for C3 and place in her file. LPA will return at a later time to clear the citation.
Type B
Section Cited
CCR
101162(a)(1)


This requirement is not met as evidenced by: This requirement is not met as evidenced by:101162(a)(1) Licensees shall reveal each child care center license number in all advertisements in accordance with Health and Safety Code Section 1596.861. This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPAs observation upon initial walk up towards the entrance, LPA noticed a banner advertising care. The facility did not meet the section above and did not include their facility licensing number on the advertisement. This poses/posed a potential health, safety or personal rights risk to persons in care
POC Due Date: 07/03/2026
Plan of Correction
1
2
3
4
Facility representative agrees to add the facility number onto the advertisement, or completely remove the advertisement. LPA will return at a later time to clear the citation.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2026


LIC809 (FAS) - (06/04)
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