401712199-12-18-2024-17-CC-MSAN-DC2VEQ-20241217152243

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401712199
Report Date: 12/17/2024
Date Signed: 12/18/2024 08:33:42 AM

Document Has Been Signed on 12/18/2024 08:33 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	TRINITY LUTHERAN PRESCHOOL		FACILITY NUMBER:	401712199
ADMINISTRATOR/ DIRECTOR:	KIMBERLY NORMAN		FACILITY TYPE:	850
ADDRESS:	940 CRESTON ROAD		TELEPHONE:	(805) 238-0335
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 60	CENSUS:	DATE:	12/17/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:30 PM
MET WITH:	Tiffany Valaau		TIME VISIT/ INSPECTION COMPLETED:	03:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/17/24, at 1:30 PM, Licensing Program Analyst (LPA) Matthew Sapien conducted an unannounced Annual Random Inspection of the abovementioned Child Care Center (CCC). LPA met with Tiffany Valaau, Director of the CCC, and explained the nature and purpose of the inspection. The LPA, in the company of the Director, toured the interior and exterior of the CCC. The CCC utilizes two rooms (classroom #2 for children ages 3-4 and a snack room for the same children), an outdoor playground, and 2 restrooms with 2 restrooms each. Importantly to note, the CCC possesses two additional classrooms (totaling 4 classrooms), however, these aren't currently in use due to the current amount of kids. The CCC is located on the grounds and campus of Trinity Lutheran Church Paso Robles. The CCC's hours of operation are 7:30 AM until 12:00 PM Monday through Friday. During the inspection, the LPA observed no children in care along with two additional staff members (school principal being one; all cleared and associated). The two inside rooms of the CCC are clean and orderly. The classrooms have age-appropriate toys, books, and other furnishings for children in care. The snack room contains a mini operational refrigerator that has food items for the CCC's children. The CCC provides a morning snack for the children, while lunches are eaten at home upon dismal time at 12:00 PM. There is available drinking water for children throughout the CCC with a filtered water jug and with bottled water. Children bring water bottles from home so that the proper amounts are being monitored and consumed. CCCs constructed before 1/1/20, are supposed to test their water (used for drinking and food preparation) for lead contamination before 1/1/23, and then every 5-years except after the date of the first test. For child care center licenses issued after 7/1/22, 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 outlined in PIN 21-21.1-CCP. (CONT. LIC 802-C)

Maria Mueller	TELEPHONE: (805) 562-0400
Matthew Sapien	TELEPHONE: (805) 562-0400
	DATE: 12/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: TRINITY LUTHERAN PRESCHOOL	FACILITY NUMBER: 401712199
	VISIT DATE: 12/17/2024

NARRATIVE

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LPA observed snack menus and required notices and other relevant documents posted prominently throughout each of the classrooms. LPA also reviewed the children's sign in/sign out forms and found the arrival times of children, along with the departure times. The signatures of authorized representatives were also present.

LPA observed a carbon monoxide detector in each of the two classroom of the CCC. In classroom #2, the detector which was tested at 1:47 PM, while at 1:53 PM the detector in the snack room was tested. Each detector was found to be operational. Cleaning compounds, sharps, and medication are stored in elevated cabinets in each of the two classrooms. Medication is kept in secure box in the snack room in an elevated cabinet. A First Aid kit was also observed.

The CCC utilizes 2 restrooms, which possess 2 toilets each. The bathrooms were found to be clean, orderly, and rid of any hazardous items for children in care.

The outdoor playground area is enclosed by metal fencing throughout. The fence’s entry/exit gates are secure and furnishings in the area are age appropriate. The play structures in the outdoor play area have adequate cushioning material (bark) to absorb falls. The footing of the exterior is varied (natural grass, concrete pavement, bark, and dirt). Shade is provided by a mixture of building overhangs and by trees throughout the perimeter. LPA observed a large shed in the playground. Director informed LPA that bikes and other childcare equipment are stored there. Director attested that children are supervised at all times while outside and that the outdoor area is inspected prior to letting children outside.

A sampling of staff and children records were reviewed. The children’s records were complete and were found to contain emergency contact information as well admission agreements, among other relevant licensing documents and forms. Staff records were reviewed and contained current pediatric CPR and First Aid certifications (EMSA approved) and Mandated Reporter Training certificates. Facility records show the last fire drill on site occurred on 9/5/24. LPA confirmed that there are no bodies of water, firearms, or ammunition that are stored on site.

This facility does currently provide Incidental Medical Services – IMS. LPA reviewed storage of medication (CONT. 809-C, Page 3)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Matthew Sapien	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: TRINITY LUTHERAN PRESCHOOL	FACILITY NUMBER: 401712199
	VISIT DATE: 12/17/2024

NARRATIVE

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and supplies. LPA also reviewed children’s, personnel, and administrative records in relation to IMS services. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was reminded that all adults 18 and over, including employees and volunteers,as specified in HSC 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.

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

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.

During today's visit, no deficiencies were issued. Director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

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, Tiffany Valaau.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Matthew Sapien	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

LIC809 (FAS) - (06/04)

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