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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408247
Report Date: 04/06/2023
Date Signed: 04/06/2023 07:13:36 PM

Document Has Been Signed on 04/06/2023 07:13 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:FIRST LUTHERAN PRESCHOOLFACILITY NUMBER:
073408247
ADMINISTRATOR:MARIANNA BARRYFACILITY TYPE:
830
ADDRESS:4006 CONCORD BLVDTELEPHONE:
(925) 798-5330
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY: 6TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
04/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jeni SmithTIME COMPLETED:
04:30 PM
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On 04/06/2023 at 2:30 PM, Licensing Program Analysts (LPA) Christina Watts conducted an unannounced Annual inspection at First Lutheran Preschool - Infant Program. Facility is located on the grounds of First Lutheran Church. LPA met with Director, Jeni Smith and explained the purpose of this inspection. During today's inspection, there were 4 children in care with 1 qualified teacher in the room. Director stated there are 5 children enrolled. All staff in the facility have Criminal Record Clearance. Facility's operating days and hours are Monday - Friday 6:30 AM - 6:00 PM.

Indoor Space: physical plant was inspected and toured with Director. Infant room (Nedo) is located in gym area. LPA observed infants were napping under the visual supervision of a teacher. Rooms, restrooms, and in use areas were inspected. Food and feeding bottles were labeled and stored safely. Food storage areas were sanitary, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair. Napping area had cribs and was cordoned off from the activity area by dividers. The infant changing table has raised sides that are at least 3 inches in height, has a vinyl changing pad is at least 1 inch thick and in good condition. Napping equipment is appropriate. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Cabinets, drawers, and rooms used for storage were locked. Floors were clean and free from tripping hazard. LPA observed a working fire extinguisher, smoke and carbon monoxide detectors. Log shows that the last Fire Drill was conducted on March 2023. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles. Facility’s License, Parents’ Rights Poster PUB 393, Personal Rights, Activity Schedules, and Menus were observed to be posted.

Outdoor Space: Outdoor activity space was inspected and observed to be safe. The play equipment is age appropriate and maintained in good condition and free of hazards. There were no bodies of water observed. *CON'T ON PAGE 2*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: FIRST LUTHERAN PRESCHOOL
FACILITY NUMBER: 073408247
VISIT DATE: 04/06/2023
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*PAGE 2*

File Review: Sign in and out procedures and logs were reviewed. A sampling of Infant and Staff files was taken for review. LPA reviewed the Needs and Services Plan for all infants which were updated quarterly. Reviewed Individual Safe Sleep Plan LIC 9227 and Sleep Log for each infant. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. A copy of Children Roster and Personnel Report was obtained

On or before March 30, 2018, any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided:


https://www.mandatedreporterca.com/training/child-care-providers. All staff has current Mandated Reporter certificate in file. Facility completed state required lead testing and submitted documentation to licensing. LPA reminded the Director facility is required to test for lead every 5 years.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
LIC809 (FAS) - (06/04)
Page: 2 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: FIRST LUTHERAN PRESCHOOL
FACILITY NUMBER: 073408247
VISIT DATE: 04/06/2023
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*PAGE 3*

Director 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.

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.

In the areas that were evaluated, no regulatory violations were observed.

Exit interview conducted and report was reviewed with Director, Jeni Smith. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5