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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421700134
Report Date: 02/09/2024
Date Signed: 02/09/2024 03:47:44 PM


Document Has Been Signed on 02/09/2024 03:47 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:GRACE LUTHERAN PRESCHOOLFACILITY NUMBER:
421700134
ADMINISTRATOR:KATHY LYNN LEDOUXFACILITY TYPE:
850
ADDRESS:420 EAST FESLERTELEPHONE:
(805) 922-5419
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:63CENSUS: 17DATE:
02/09/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Debbie SharerTIME COMPLETED:
03:55 PM
NARRATIVE
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On 2/9/2024 at 12:00 PM Licensing Program Analyst, (LPA) Gigi Reyes conducted an unannounced Case Management Inspection and met with Deborah Sharer, Teacher -in-charge. LPA discussed the purpose of the inspection with Director Kathy Ledoux by phone who was out of the Child Care Center when LPA arrived. LPA observed 17 children under the care of 4 staff.

Approximately 30 minutes later the President of School Board, Mildred Smith arrived at the CCC and provided LPA her CA Driver's License and copy of Request for Live Scan Services Form (LIC 9163). Shortly thereafter, Director Kathy Ledoux arrived.

Upon review of Roster report, it was found out that Mallorie R. Galvez has no criminal record clearance/exemption transferred and associated to CCC and has been working at the CCC since October 9, 2023, therefore a civil penalty of $500.00 will be assessed.

During file review, it was noted that S1 still lacks immunization records, marking the second instance of the same violation for the individual at the CCC, which indicates that violation was never corrected since June 17, 2021. File review revealed the Staff 1 has not taken the Mandated Reporter Training per AB 1207. S1 teacher qualification was verified.

Further, since director was not present at the CCC upon LPA's arrival, S1 was in charge of the CCC. However, Designation of Responsibility (LIC308) was not posted at the CCC.
Continued on LIC 809C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024
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 5


Document Has Been Signed on 02/09/2024 03:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: GRACE LUTHERAN PRESCHOOL

FACILITY NUMBER: 421700134

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 02/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
Section Cited
HSC
1596.8662(b)(1)

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(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... This requirement is not met as evidenced by
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Director agreed to submit the plan of correction to CCL no later than 2/16/2024 and submit it to CCL, gigi.reyes@dss.ca.gov
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During review of S1's file, it was noted that S1 has not taken the Mandated Reporter training. This poses a potential risk to health and safety of children in care.
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Type B
02/09/2024
Section Cited
CCR101215(C)(1)

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(c) The child care center director shall be responsible for the operation of the center, for compliance with regulations, and for communications with the Department; and has the authority to acknowledge receipt of deficiency noticees and to correct deficiencies... This requirement is not met as evidenced by:
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Director filled out and signed the LIC 308 at the time of inspection.
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During the inspection, since director was not present, S1 was appointed to be in charge, however, LPA did not observe the LIC 308, Designation of Responsibility disignating the teacher in charge, Deborah Sharer.
This poses a potential risk to health and safety of children in care.
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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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/09/2024 03:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: GRACE LUTHERAN PRESCHOOL

FACILITY NUMBER: 421700134

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 02/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2024
Section Cited
HSC
1596.7995

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(a) (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. This requirement is not met as evidenced by
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Staff 1 stated she was never asked to submit but she agreed to submit the proof no later than 2/16/2024.
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During file review,it was noted that S1 still lacks immunization records, marking the second instance of the same violation for the individual at the CCC, which is an indicatie that violation was never corrected. This poses a potential risk to health and safety of children in care.
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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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GRACE LUTHERAN PRESCHOOL
FACILITY NUMBER: 421700134
VISIT DATE: 02/09/2024
NARRATIVE
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LPA Reyes informed Director that this report dated 2/9/2024 documents one (1) Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Also, LPA Reyes informed the Director, Ms. Ledoux to provide a copy of this licensing report dated 2/9/2024 that documents any Type A citation 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.

During today's inspection deficiencies were cited under Title 22 Division 12 and health and safety code.

Notice of Site Visit was issued and must be posted for 30 days.

Exit interview was conducted and report was reviewed with Director Kathy Ledoux.








Continued on LIC 809D
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5
Document Has Been Signed on 02/09/2024 03:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: GRACE LUTHERAN PRESCHOOL

FACILITY NUMBER: 421700134

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 02/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/12/2024
Section Cited
CCR
101170(e)(3)

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(e) All individuals... (3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 101170.1(r), unless, upon request for a transfer, This requirement is not met as evidenced by
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Director agreed for the staff not to be present at the CCC until the criminal record clearance/exemption transfer is completed. POC letter should be submitted.no later than Monday, 2/12/2024.
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Durng inspection, LPA Reyes reviewed the Roster report and it was found out that Mallorie Galvez was not on the list and has been working since 10/9/2024. This poses an immediate risk to health and safety of children in care.
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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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5