Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200465
Report Date: 05/24/2018
Date Signed: 05/24/2018 01:33:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SHERMAN OAKS LUTHERAN CHILDREN'S CENTERFACILITY NUMBER:
191200465
ADMINISTRATOR:DIANE NIXONFACILITY TYPE:
850
ADDRESS:14847 DICKENS STREETTELEPHONE:
(818) 784-9480
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:78CENSUS: 7DATE:
05/24/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Diane Nixon - Director TIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Peter Flores conducted a 3 Year Annual site visit and met with the facility's Director Diane Nixon, who guided the LPA on a tour of the facility indoors and outdoors.

The following were observed during the inspection:
1. No bodies of water were observed at the time of inspection.
2. According to the center director, there are no weapons or firearms at the facility.
3. All children were under supervision, including visual supervision, of a teacher at all times.
4. The LPA was allowed entrance to the facility to conduct the inspection.
5. There is a ratio of one teacher supervising no more than 12 children in attendance.
6. Disinfectants, cleaning solutions, poisons, and other dangerous items were made inaccessible to children in care.
7. Storage areas for poisons were observed to be locked.
8. All materials and surfaces accessible to children were observed to be toxic free.
9. Medication was observed by LPA. Facility provides Incidental Medical Services (IMS).
10. All toilets and hand washing facilities were observed to be safe and sanitary operating conditions.
11. All floors were observed to be clean and safe.
12. Furniture and equipment were observed to be in good condition, free of sharp, loose, and pointed parts.
13. All kitchen, food prep, and storage areas were observed to be clean, free of litter, rubbish, and rodents/vermin.
14. All food is protected from contamination.
15. Uncontaminated drinking water was observed to be available both indoors and outdoors.

(Continued)
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
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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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHERMAN OAKS LUTHERAN CHILDREN'S CENTER
FACILITY NUMBER: 191200465
VISIT DATE: 05/24/2018
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16. Menus for snacks and lunch were observed.
17. Facility functioning carbon monoxide detector(s) that meet statutory requirements.
18. Playground equipment is in good condition, free of sharp, loose, or pointed parts.
19. Areas around high climbing equipment and slides have cushioning material to absorb falls.
20. Licensee was observed to be operating within the conditions, limitations, and capacity specified on the license.
21. Staff has current CPR and Pediatric 1st Aid certificates.
23. LPA observed full legal signatures during inspection of the sign in and sign out boards.
24. LPA observed all children were signed in and signed out by the person(s) responsible for the child(ren).

The following was thoroughly discussed with the licensee:
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

Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders.



(Continued)
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2018
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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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHERMAN OAKS LUTHERAN CHILDREN'S CENTER
FACILITY NUMBER: 191200465
VISIT DATE: 05/24/2018
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Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis, and measles. Influenza waiver was discussed.

Beginning on January 1, 2018, AB 1207, 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. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com

AB 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

Licensee was reminded it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations.

An exit interview was conducted and a copy of this report was given Director Diane Nixon.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2018
LIC809 (FAS) - (06/04)
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