561711043-8-10-2022-17-CC-ARIS-CH6W3A-20220810165538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 561711043
Report Date: 08/10/2022
Date Signed: 08/10/2022 04:55:53 PM

Document Has Been Signed on 08/10/2022 04:55 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:	KING OF GLORY PRESCHOOL		FACILITY NUMBER:	561711043
ADMINISTRATOR:	LYNDA MACDONALD		FACILITY TYPE:	850
ADDRESS:	2500 BORCHARD ROAD		TELEPHONE:	(805) 498-0567
CITY:	NEWBURY PARK	STATE: CA	ZIP CODE:	91320
CAPACITY:	75	CENSUS: 35	DATE:	08/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Shannon Meyerson		TIME COMPLETED:	05:15 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 August 10, 2022 at 9:55 AM, Licensing Program Analyst (LPA) Austin Rios conducted a Required Annual inspection. LPA met with director Shannon Meyerson and explained the purpose of the inspection. LPA asked Covid-19 screening questions prior to entering the facility. LPA conducted a tour of the facility inside and out. There were 35 children in care at the time of the inspection and six staff. The center operates from 7:00 AM to 5:30 PM and is open Monday thru Friday.

Licensing required notices were posted prominently at the front entrance and inside the front office. The facility uses five classroom. Bathrooms were observed to be clean and free of toxins. Upstairs bathrrom had five stalls. The fifth classroom located downstairs had its own restrooms. There is water inside and outside for the children to have access too. The outdoor playground is completely enclosed by a fence. The playground has an ample amount of shade available and age appropriate toys/equipment. LPA did not observe any toxins/hazardous items accessible to children. The classroom has age appropriate toys and furniture available for children. There is a functioning carbon monoxide detector that meets statutory requirement. LPA observed and reviewed the posted lunch menu. The center provides AM and PM snack. The daily schedule was posted in the classrooms. The last fire drill was conducted 7/20/2022. Center uses electronic sign in sheet.

Facility did not have four individuals fingerprinted and associated to the facility. California Code of Regulation, (Title 22 Division 12 101170(e)(1)) type A deficiency and civil penalty assessed is being cited on the attached LIC 809 D).

Cont. on 809C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: KING OF GLORY PRESCHOOL	FACILITY NUMBER: 561711043
	VISIT DATE: 08/10/2022

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
26
27
28
29
30
31
32

A sampling of children and staff records were reviewed and found current. At least one staff present has current Pediatric First Aid/CPR certificates that expire on 8/26/2022. Teachers present have current AB 1207 Mandated Reporter Training certificates that expire on 12/31/2022.

LPA Austin Rios informed facility representative that this report dated 8/10/2022 Type A citation 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 Austin Rios informed the facility representative to provide a copy of this licensing report dated 8/10/2022 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 Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Licensee was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 08/10/2022 04:55 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: KING OF GLORY PRESCHOOL	FACILITY NUMBER: 561711043
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type A

Section Cited

CCR

101170(e)(1)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or 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 in count out four individuals not being assoicated to the facility which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/10/2022
	Plan of Correction
1 2 3 4	Facility will have staff that was not in the system fingerprinted and submit a transfer request for the other three individuals as two were seperated and the third was associated with another faciltiy. Facilty will also submit to LPA Rios a written plan of correction on how they will prevent this from happening again by 8/17/2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: KING OF GLORY PRESCHOOL	FACILITY NUMBER: 561711043
	VISIT DATE: 08/10/2022

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
26
27
28
29
30
31
32

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the director Shannon Meyerson

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4