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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597634
Report Date: 05/08/2024
Date Signed: 05/08/2024 02:12:32 PM

Document Has Been Signed on 05/08/2024 02:12 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:HOPE LUTHERAN PRESCHOOLFACILITY NUMBER:
191597634
ADMINISTRATOR/
DIRECTOR:		HEAD, ELLENFACILITY TYPE:
850
ADDRESS:1041 E. FOOTHILL BLVD.TELEPHONE:
(626) 335-5315
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY: 48TOTAL ENROLLED CHILDREN: 0CENSUS: 40DATE:
05/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:01 PM
MET WITH:Ellen Head - DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analysts (LPA) Cynthia Reyes conducted an announced Case Management Deficiencies inspection on this date for the purpose of inspecting the facility to ensure the health and safety standards as required by the regulations governing childcare centers are met. Upon arrival LPA met with Director, Ellen Head and the nature of the inspection was discussed.

During a walk through of the facility and Interview with Director Head, LPA observed four (4) children not signed in on the sign in/out log. Director was present and observed the log at the same time as the LPA. A request was made by the LA for a copy of the staff personnel report (LIC 500) and a coy of the children roster (LIC 9040), Per conversation with Director Head, she stated its on her computer and she is not able to print them out. This has been an issue on several occasions where the Director is not able too provide a copy of both documents. LPA had Director write out the staff Personnel report on this date. It was also brought to the LPA attention on this date that a child has been in care for about a month now and just turned 2 years old today 05/08/2024. (LPA obtained copies of child enrollment packet). Per conversation with Director Head, she stated the child has only been in care for week.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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
Document Has Been Signed on 05/08/2024 02:12 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 05/08/2024 at 01:19 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HOPE LUTHERAN PRESCHOOL
FACILITY NUMBER: 191597634

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2024
Section Cited
CCR
101229.1(b)

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Sign In and Sign Out (b) The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement is not met as evidenced by: Based on LPA observation, the licensee did not comply with the section cited above. There were 40 children in care and 4 were
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Director states, will remind all parents to sign there child in/out, and will send a notification to all parents. Director will submit a written statement to the LPA by 5/10/24 of what was sent to parents/guardians and what steps she will take to ensure all parents/guardians are reminded to sign their child in/out.
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not signed in, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
05/10/2024
Section Cited
HSC1596.841

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Current Roster of Children Provided Care in Facility Required: Each child day care facility shall maintain a current roster of children who are provided care in the facility. This requirement was not met as evidenced by the facility not having a complete roster available. This poses a potential risk to the health and safety of children in care.
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Director stated she will complete/update and email a copy of the children's roster by the plan of correction (POC) date 05/10/2024.
Type B
05/10/2024
Section Cited
CCR
101217(a)

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Personnel Records. Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information. This requirement is not met as evidenced by no current copy of the Personnel Report (LIC 500). This poses a potential health and safety risk to the children in care.
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Director stated she will submit a current copy of the staff Personnel Report (LIC 500) to LPA by the plan of correction (POC) due date 05/10/2024.

Director wrote out the personnel report on this date.
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:Christina Gabelman
LICENSING EVALUATOR NAME:Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/08/2024 02:12 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 05/08/2024 at 01:45 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HOPE LUTHERAN PRESCHOOL
FACILITY NUMBER: 191597634

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/08/2024
Section Cited
CCR
101161(A)

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Limitations on Capacity and Ambulatory Status. The licensee shall not exceed the conditions, limitations and capacity specified in the license. Based on interview and LPA observation of documents, an infant had been enrolled and in care and commingling with preschool children for about a month
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Director states with submit to the department in writing the department will take to ensure children are not commingled at the facility and the step she will take to ensue the enrollment process is completed correctly to ensure the chid is the correct age when the child starts in the licensed preschool. Send POC by 5/10/24
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before he turned 2 years old. This poses an immediate health and safety risk to the children in care.
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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:Christina Gabelman
LICENSING EVALUATOR NAME:Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024


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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HOPE LUTHERAN PRESCHOOL
FACILITY NUMBER: 191597634
VISIT DATE: 05/08/2024
NARRATIVE
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Type A - A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form LIC9224 during this visit.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Director, Ellen Head.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
LIC809 (FAS) - (06/04)
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