191590557-8-11-2022-33-CC-CRES-CH7T3L-20220811142231

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191590557
Report Date: 08/11/2022
Date Signed: 08/11/2022 02:22:43 PM

Document Has Been Signed on 08/11/2022 02:22 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	FIRST LUTHERAN PRESCHOOL		FACILITY NUMBER:	191590557
ADMINISTRATOR:	JOANA AFUANG		FACILITY TYPE:	850
ADDRESS:	1227 SOUTH MAGNOLIA AVENUE		TELEPHONE:	(626) 303-3950
CITY:	MONROVIA	STATE: CA	ZIP CODE:	91016
CAPACITY: 40	TOTAL ENROLLED CHILDREN: 40	CENSUS: 0	DATE:	08/11/2022
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Joana Afuang		TIME COMPLETED:	03:30 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	Licensing Program Analyst (LPA) Cynthia Reyes, conducted an announced annual inspection to reopen the facility as it was on inactive status for a year. LPA met with Director, Joana Afuang and a copy of the Entrance Checklist for Child Care Centers form (LIC 125) was provided. A risk assessment was conducted prior to entering the facility. Due to COVID- 19 precautionary measures were taken during the entire inspection and LPA wore appropriate personal protective equipment. This is a Preschool program that consist of 4 class rooms (Class rooms: Butterflies, Lady Bugs, Dragon Flies and caterpillar). This program will serve preschool children ages 2 to 5. The preschool operates 7AM to 6PM. Monday to Friday. 1PM Director lead LPA on a tour of the facility beginning at the front office. Sign-In and Sign-Out will be at the front entrance using a tablet with the Bright wheel application. Parents are allowed inside the center/class rooms, which all precautionary measures will be taken still at this time. Health check questions will documented by parents on bright wheel and the physical check which include temperature being taken of children will be conducted by staff when the child enters the class room. Use of hand sanitizer will also be available. Facility was observed to be adhering to local public health guidelines. (According to CDC guidelines, children under the age of (2) are not required to wear masks.) All areas identified on the Facility Sketch were inspected. The following was observed during the tour of the preschool, no children are in care at this time. The lady bug class room is not used at this time due to low enrollment. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were observed to be inaccessible to children. Joana states there are no poisons, weapons or firearms located at the facility. PAGE 1 OF 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FIRST LUTHERAN PRESCHOOL	FACILITY NUMBER: 191590557
	VISIT DATE: 08/11/2022

NARRATIVE

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Teacher-child ratios were discussed in accordance with Title 22 Regulations. No staff names were recorded. No children In care at this time> LPA discussed that children should be under supervision and observation, including visual supervision, of a teacher at all times. The licensed facility is within the conditions, limitations, and capacity specified on the license. The office will be used as an ill/isolation area for children. LPA observed an ill child cot/mat available. Ill children will use the staff restroom located next to the kitchen. The ill child will only walk through the kitchen on rainy days & other days use the outside walk way to get to the outside door leading to the rest room.

145 PM Furniture, equipment and toys were observed and inspected to be clean, safe and age appropriate and in good repair. Telephone service, heating, lighting and ventilation were evaluated. Preschool children have their own cubby to store their personal belongings. LPA observed napping equipment/bedding, and was inspected to be in good condition, appropriate storage and cleanliness. Linens are washed weekly.

Menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Menus for the past 30 days are available upon request. The school will provide AM/PM snack and child will bring their own lunch. Snacks were reviewed for availability, quantity and appropriateness to children in care. LPA advised the Applicant to label and date all food, dishes and bottles that are brought from home for proper storage. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. The licensee takes measures to keep the facility free of flies, other insects and rodents. All food is protected from contamination, and LPA inspected that any contaminated food is discarded immediately. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair.

2 PM The outdoor playground was inspected and the play equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. LPA did not observe any bodies of water on the premises. The Preschool play yard is surrounded by a gate.

There is drinking water available indoors and outdoors by use of pitcher/jugs and disposable cups. Sippy cups & water bottles will be labeled if brought by the child.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FIRST LUTHERAN PRESCHOOL	FACILITY NUMBER: 191590557
	VISIT DATE: 08/11/2022

NARRATIVE

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Director Joana 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.

Children’s Records were not reviewed, however will be in the future for completeness; Inspection of required forms will be made and documented on the LIC 857. LPA did not review Staff record, which would be documented on the LIC 859. Staff who will be present should have proof against TB, measles, pertussis, and influenza, as well as current Mandated reporter.

2:30PM There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Pediatric CPR & First Aid is current for the Director. Exp. 07/20/23.

Medication: This facility provides Incidental Medical Services – IMS. No children at this time to review storage of medication and equipment/supplies, and no review of 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

Children's roster was not reviewed as the facility was on inactive status for a year. Disaster drill log was available and ready to document drills and will be posted visibly for all to see.

First Aid supplies were observed in each classroom and were observed to contain the required first-aid supplies. According to Director medication is only administered to a child when accompanied with a doctor's note and is stored in the office. No transportation is being conducted by the facility.

Update: Effects of Lead Exposure and the following Provider Information Notices (PINs) Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD. were discussed.
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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FIRST LUTHERAN PRESCHOOL	FACILITY NUMBER: 191590557
	VISIT DATE: 08/11/2022

NARRATIVE

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3PM Carbon monoxide detectors and smoke detectors are present and are in operable condition in the facility. Smoke and Carbon Monoxide detectors should be checked, and batteries replaced as needed. LPA observed they are both located in each classroom, as well as the fire extinguisher type 2A-10BC and the valve on each indicated that they are all fully charged and each has a tag with a service date of 05/18/2022. Fire extinguishers need to be serviced annually or as often as necessary

Access forms, regulations and quarterly updates on the Child Care Licensing website at www.ccld.ca.gov. Reporting Unusual Incidents: MPROIncidentReports@dss.ca.gov. CCL Resources for Parents & Providers: https://ccld.childcarevideos.org/ Provider Information Notices (PINs): https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

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. ***(No care tool was used on this date, however documents were provided)***

There were no deficiencies cited during today’s inspection.
A notice of site visit was given and must remain posted for 30 days. The facility will be removed from the inactive status list and is ready to reopen as of this date.

3:30PM Exit interview conducted and report was reviewed with the facility representative, .

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC809 (FAS) - (06/04)

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