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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200465
Report Date: 09/18/2024
Date Signed: 09/24/2024 03:19:29 PM

Document Has Been Signed on 09/24/2024 03:19 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SHERMAN OAKS LUTHERAN CHILDREN'S CENTERFACILITY NUMBER:
191200465
ADMINISTRATOR/
DIRECTOR:		KIMBERLY OGASFACILITY TYPE:
850
ADDRESS:14847 DICKENS STREETTELEPHONE:
(818) 784-9480
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY: 78TOTAL ENROLLED CHILDREN: 78CENSUS: 31DATE:
09/18/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:36 AM
MET WITH:Arusiak GrigoryanTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 9/18/2024 Licensing Program Analyst (LPA), Suzette Ornelas conducted unannounced required annual inspection at the address mentioned above. LPA met with Lead Teacher, Arusiak Grigoryan, and discussed the purpose of the visit. The Director guided LPA on a tour of the facility inside and out. Days and hours of operation are Monday through Friday 7:00am to 6:00pm.

LPA observed all required postings in a prominent area. LPA observed 31 children and 6 adults. All children are under supervision, including visual supervision, of a teacher at all times. Capacity and limitations as specified on the license are being maintained. A walk through of the classroom area was conducted.

All areas identified on the Facility Sketch were inspected.


RM Cheetah:
RM Lion: Not In Use
RM Tiger:
RM Monkey:
RM Giraffe: Not In Use
RM Rhino:
RM Hippo: Not In Use
RM Elephant:
RM Zebra:

A walk through of the classroom room space was conducted, the space was found to be clean and free from any potential hazards. Furniture was found to be in good repair and age appropriate. There is adequate heating, lighting and ventilation. Isolation area for sick students is in the Director’s office. LPA observed adequate arrangements for isolation and care of ill children.
SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHERMAN OAKS LUTHERAN CHILDREN'S CENTER
FACILITY NUMBER: 191200465
VISIT DATE: 09/18/2024
NARRATIVE
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The bathroom and toileting areas were inspected, LPA observed toilets and sinks to accommodate the facility’s capacity. Facility is equipped with 7 toilets, 9 sinks and 2 urinals. Toilets/urinals flush properly, toilet/urinals and sinks are reachable by the children in care. The restrooms have adequate toilet paper and paper towels available. The bathrooms were found to be clean. There is adequate lighting/ventilation in the bathroom area.

Playground equipment is in safe condition and free of hazards. The surface of the outdoor activity space is not maintained in a safe condition and/or free of hazards. LPA observed playground surface material to have multiple holes throughout which pose a potential risk to children in care. LPA also observed paint chipped throughout the facility and a small hole in the classroom that needs to be repaired. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. All kitchen, food preparation and storage areas are clean and safe. Per lead teacher, food program provides daily meals for children enrolled, parents provide daily meals for children who are not enrolled in the food program and school provides snacks as needed. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is readily available both indoors and outdoors via water dispensers located in both classrooms. The facility is equipped with a working smoke detector and carbon monoxide detector. LPA observed fire extinguishers (2A 10BC) located throughout the facility with service date of 10/20/2023. There is no swimming pool or other bodies of water on the premises. First Aid Kit was observed to be complete. Fire Drill log was observed to be complete and current. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection.

The facility has sufficient cots or mats for napping. Each mat or cot is occupied by only one child at time. LPA reviewed a sample of children’s files and observed files were complete. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have not received a criminal record clearance or exemption. CPR and Pediatric First Aid certificates were observed to be current. The name of the child care center director or fully qualified teacher(s) designated to act in the director’s absence has been reported to the Department. LPA reviewed a sample of staff files and observed files were complete.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication:


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SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHERMAN OAKS LUTHERAN CHILDREN'S CENTER
FACILITY NUMBER: 191200465
VISIT DATE: 09/18/2024
NARRATIVE
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Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

LPA and Administrator discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

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.

Administrator 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.

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 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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.
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SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/24/2024 03:19 PM - It Cannot Be Edited


Created By: Suzette Ornelas On 09/18/2024 at 04:00 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SHERMAN OAKS LUTHERAN CHILDREN'S CENTER
FACILITY NUMBER: 191200465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Lead teacher was able to provide LEAD testing results after care tool was closed. Deficiency was cleared today.
POC Due Date: 09/18/2024
Plan of Correction
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deficiency will be cleared, lead test results obtained.
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above, surfaceof the front play yard is in need of repair due tomultiple holes throughout the rubber surface and facility is in need of painting as there is chipped paint throughout the facility. LPA observed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/30/2024
Plan of Correction
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Facility will repair surface paint chipped walls.
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:Raul Navarro
LICENSING EVALUATOR NAME:Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/24/2024 03:19 PM - It Cannot Be Edited


Created By: Suzette Ornelas On 09/18/2024 at 04:18 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SHERMAN OAKS LUTHERAN CHILDREN'S CENTER
FACILITY NUMBER: 191200465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 3 staff did not have fingerprint clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2024
Plan of Correction
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Lead teacher sent all 3 staff to obtain fingerprint clearance, waiting on eligibility. Lead teacher/director/anyone in charge of hiring shall watch Background Check Requirements for Caregivers at ccld.childcarevideos.org and submit a summary of what was learned to LPA via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Raul Navarro
LICENSING EVALUATOR NAME:Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024


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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHERMAN OAKS LUTHERAN CHILDREN'S CENTER
FACILITY NUMBER: 191200465
VISIT DATE: 09/18/2024
NARRATIVE
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, 1 type B deficiency is being cited. (See LIC809-D)

1 Type A deficiency is being cited on the attached LIC9099-D.



A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next twelve (12) months. The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with lead teacher, Arusiak Grigoryan.



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SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC809 (FAS) - (06/04)
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