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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700265
Report Date: 08/26/2024
Date Signed: 08/26/2024 01:43:53 PM

Document Has Been Signed on 08/26/2024 01:43 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GRACE LUTHERAN PRESCHOOLFACILITY NUMBER:
430700265
ADMINISTRATOR/
DIRECTOR:		MCDERMOTT, PENNYFACILITY TYPE:
850
ADDRESS:3149 WAVERLEY STREETTELEPHONE:
(650) 494-1212
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 12DATE:
08/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Gina Rogge TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On August 26, 2024 at 11:15 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced Annual Random Inspection and met with facility representative Gina Rogge. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representative. There were 12 preschool age children present during this inspection and two (2) additional staff members. The facility was toured inside and out for a health and safety inspection. The hours of operation are 9:00 AM-3:30 PM, Monday -Friday

LPA checked the facility RECORDS and they show all individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. LPA conducted a census of the children and the census matches the children signed in on the electronic system and on the sign in sheet. LPA reviewed three (3) children's files and three (3) staff files around 11:30 AM. All staff files have required health screening, and Employee Rights forms, and all children files contains Personal Rights, Medical Consent forms, and Identification & Emergency Information. LPA reviewed the facility roster. and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate.

The one (1) classroom was inspected around 12:00 PM and teacher child ratio was observed. There are adequate play and learning materials available. The floors are well maintained and the furniture is the correct size for preschool children. The classroom equipment is in good repair and the room temperature is adequate for children in care. There is proper individual storage space for each child and the cubbies have their pictures posted on the shelves. The isolation area for sick children is next to the director's desk area, away from other children in care.

LPA tested the centers dual smoke & carbon monoxide detector and found it to be functioning properly. The center has a working telephone, and a fully charged 2A10BC fire extinguisher hanging on the wall by the back door, which meets standards established by the State Fire Marshal. Disaster drills are being conducted at least once every 6 months and the last one conducted was on 03/01/2024. All required documents are posted in a public accessible area.

See 809-C.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GRACE LUTHERAN PRESCHOOL
FACILITY NUMBER: 430700265
VISIT DATE: 08/26/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/

LPA observation during the visit:

When I arrived at the facility all of the children were on the playground, mostly playing. Some children were being pushed on the swings by a staff member while others played on some of the small play structures. There were a total of three staff members on the yard... space out in different sections of the playground supervising children. At 12:00 PM, the children went inside of the classroom and washed their hands, while one staff member greeted the parents who were picking up their children, while the other staff member gathered the lunch boxes for the children to eat. At 12:15 PM, the staff members began getting out the cots for the children to sleep while playing soft music.



The parents provides breakfast, lunch, and snacks for the children. All storage containers for solid waste have tight fitting covers that are in good repair.

The outdoor area has a large play structure with a slide that has cushioning underneath to absorb children's falls and a swing set that's anchored to the ground. The playground also has a large sandbox with a canopy overhead that provides shade to children while at play. Per director, the staff brings the children's water bottle and cups to the yard to keep the children hydrated. The play equipment is age appropriate and in good repair. The outdoor play area is fully fenced and free of defects and dangerous condition. There are trees and canopies for shade along with seats and chairs for relaxing.



LPA checked the staff bathroom around 12:10 PM, and was told by the representative it was separate from the children’s bathroom. The staff bathroom is located in the hallway to the left of the classroom. In the classroom the children's bathroom is in the back of the classroom and all of the sinks and faucets are in safe and sanitary operating condition. There's a changing station in arms reach of a faucet with cleaning and changing supplies underneath the station. Paper towels and soap are available to the children.

California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. The licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GRACE LUTHERAN PRESCHOOL
FACILITY NUMBER: 430700265
VISIT DATE: 08/26/2024
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Lead Testing – Child Care Centers (CCC) 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. For child care 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 21-21.1CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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.

The facility representative 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.

The 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.

There are no deficiencies cited today. 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 Gina Rogge.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
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