191600684-11-5-2025-30-CC-TCHS-DN5UV6-20251105145437

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191600684
Report Date: 11/05/2025
Date Signed: 11/05/2025 02:55:05 PM

Document Has Been Signed on 11/05/2025 02:55 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOL		FACILITY NUMBER:	191600684
ADMINISTRATOR/ DIRECTOR:	NANCY J. DURKOVIC		FACILITY TYPE:	850
ADDRESS:	1100 POINSETTIA AVE.		TELEPHONE:	(310) 545-5653
CITY:	MANHATTAN BEACH	STATE: CA	ZIP CODE:	90266
CAPACITY: 125	TOTAL ENROLLED CHILDREN: 125	CENSUS: 43	DATE:	11/05/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:20 AM
MET WITH:	Carolina Noguera		TIME VISIT/ INSPECTION COMPLETED:	03:15 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	On 11/05/2025 Licensing Program Analyst (LPA) Tyra Chavies, conducted an unannounced Annual/ Random visit at FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOL. LPA toured the facility indoors and outdoors while director assisted in a classroom. LPA met with director, Carolina Noguera shortly after touring the facility. Days and hours of operation are Monday through Friday 8:00 AM to 5:30 PM. LPA Chavies confirmed the phone number is: (310) 545-5653 and email address: Director@first-lutheran.com. There were 43 children in care being supervised by 10 Staff members. LPA toured the inside and outside the facility. There are 3 different ways to enter in to the preschool, The main entrance, through the church and the back entrance. Both, main and back, entrances do have a code locked device and parents do have the code. This facility has 6 classrooms, Blue Room, Yellow Room, Red Room, Green Room, Traditional Kindergarten and Rainbow Room. All classrooms are being used a this time. The center is part of a church and does use the fellowship hall on occasions. The church is consider as an "off limit" area except once a week. LPA toured the classrooms and bathrooms. Indoor furniture and equipment are in good condition, free of sharp, loose and/or pointed parts. All bathrooms met Title 22 Health and Safety codes as well as the California Codes of Regulations.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Tyra Chavies
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOL	FACILITY NUMBER: 191600684
	VISIT DATE: 11/05/2025

NARRATIVE

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LPA also observed age appropriate toys, books, creative art work and cubbies in primary care areas. Capacity and limitations as specified on the license are being maintained. This facility does have pets (amphibian) in certain classrooms. LPA observed mats for sleeping and bedding will be taken home via the parent digestion. The facility has a working smoke and carbon monoxide detector. LPA inspected and verified that there is a 2A10BC fire extinguisher on the premises. There are no bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. All poisons are kept in a locked storage area. There is currently no Incidental Medical Services (IMS) been given at this time.

LPA toured the outside space. There are three playgrounds and a rest area. The rest area, Playground #1 and playground #3 are in the front of the main entrance and the Playground #2 is on the side of classrooms Yellow, Red and Rainbow. The director had advised LPA Chavies that the 2's are using playground #2 and the 3's and up are using playground #1 and Playground #3. The surface of the outdoor activity spaces is maintained in safe condition and is free of hazards. LPA observed age-appropriate toys, bikes and areas around climbing equipment for cushioning material to absorb falls. There are sandboxes at the facility. Director advised LPA that the sandboxes are checked at the end of the day and before the facility is open.

Director advised LPA that parents bring their own meals as well as AM/PM snack and that the facility does provided lunch on Fridays. If a parent does not bring the child's lunch, the facility will contact the parent. LPA advised director that because the facility is a full day program, per Title 22 of the California Code of Regulations the facility must provide a midmorning and midafternoon snack.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Tyra Chavies
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOL	FACILITY NUMBER: 191600684
	VISIT DATE: 11/05/2025

NARRATIVE

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If a parent does not bring the child a lunch, it is the facilities responsibility to ensure the children is provided a lunch. LPA did observe kitchen area. Per director, the facility only stores yogurt and oranges in the refrigerator. The kitchen is shared with the church. LPA observed where emergency food is stored and observed cans of alcohol on the premises. LPA did advise director the children food must be kept on a separate shelf, away from other food that do not belong to the children or facility. Pesticides and other similar toxic substances are not be stored in food storerooms, kitchen areas, food-preparation areas, or areas where kitchen equipment or utensils are stored.

Drinking water is available both indoors and outdoors upon request. Director has informed LPA Chavies, that the facility uses a filtered water system for drinking water. Per Title 22, 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. LPA received Lead Testing Results from September 2022 with an exceedance over 5.5 ppb. LPA observe documentation from September 2022 regarding fixture replacement verification. LPA was able to obtain test results from the re-test.

POSTING REQUIREMENTS: License and other relevant notices are visible for public view and correctly posted on the wall (Facility Sketch, PUB 394, LIC 9148, LIC 610A). Fire and disaster drills are being conducted as scheduled every month.

CHILDREN'S RECORDS: LPA Chavies reviewed 10 children's files. All files currently have all required Forms (LIC 700, 701, 995E, 627, LIC 9227) and immunization records.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Tyra Chavies
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOL	FACILITY NUMBER: 191600684
	VISIT DATE: 11/05/2025

NARRATIVE

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STAFF'S RECORDS: LPA Chavies reviewed 7 staff files. All files currently have all required forms ( LIC 501, 503, 508) Education and Finger print clearance. One or more person have received a First Aid/CPR certificate. Director packet has been given to LPA Lovest and is under review. LPA did advised director that some employees have expired Mandated Reporter Certificates, missing immunization records and missing TB Results. LPA advised director to ensure that all employees are following the health and safety codes governing the State of California.

The following were also discussed with the director:

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.

Director 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.

Commencing September 1^st, 2016, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Tyra Chavies
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOL	FACILITY NUMBER: 191600684
	VISIT DATE: 11/05/2025

NARRATIVE

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Law enacted by SB 277, beginning January 1^st, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into childcare or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

When regulations are approved/changed/updated, providers will be notified through Provider Information Notice (PIN).

Per Title 22 of the California Codes of Regulations, the facility is being cited for the following: Type B's and Technical Violations. (See LIC 809-D and LIC 9102)

An exit interview was conducted with Director, Carolina Noguera.

A copy of this report was read and given to Director as well as LIC 9213 (Notice of Site Visit form.)

LIC 9213 is required to be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Tyra Chavies
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/05/2025 02:55 PM - It Cannot Be Edited

Created By: Tyra Chavies On 11/05/2025 at 02:34 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: FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOL	FACILITY NUMBER: 191600684
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [ (record review)], the licensee did not comply with the section cited above in 2 out of [ (persons)] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/19/2025
	Plan of Correction
1 2 3 4	Director will ensure empolyees have taken the Mandated Reporter Training

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [ (record review)], the licensee did not comply with the section cited above in 1 out of 7 [ (persons)] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/19/2025
	Plan of Correction
1 2 3 4	Director will ensure empolyees have submitted immunization records

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Karren Starks
NAME OF LICENSING PROGRAM MANAGER:

	Tyra Chavies
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

LIC809 (FAS) - (06/04)

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