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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191602269
Report Date: 03/18/2025
Date Signed: 03/18/2025 10:37:54 PM

Document Has Been Signed on 03/18/2025 10:37 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ST. JOHN'S LUTHERAN CHURCH NURSERY SCHOOLFACILITY NUMBER:
191602269
ADMINISTRATOR/
DIRECTOR:		MARY JOSEPHINE MEADEFACILITY TYPE:
850
ADDRESS:1611 EAST SYCAMORETELEPHONE:
(310) 615-0211
CITY:EL SEGUNDOSTATE: CAZIP CODE:
90245
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 34DATE:
03/18/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Josephine MeadeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On 3/17/2025, Licensing Program Analyst (LPA), V. Wheatley and conducted an annual inspection and met with the Director Josephine Meade. LPA toured and inspected the facility and observed 34 preschool children playing on the premises playing. The children were supervised properly and were within required ratios. The children have been approved to be allowed upstairs. Hours of operation are 7:30am to 5:30pm. Capacity and limitations as specified on the license are being maintained.

Furniture and equipment was inspected for age appropriateness and good repair. LPA observed several age appropriate toys and equipment. The telephone service, heating, lighting, and ventilation is adequate. The facility has central heating and air conditioning. There are cubbies for children's belongings. There is a first aid kit in each classroom. The sheets and blankets are kept separate in the children's bags. The electrical outlets are inaccessible. LPA observed disinfectants, cleaning solutions, medication and other items are made inaccessible. No poisons were observed. LPA inspected the kitchen and observed the chemicals locked and separated from the food. The children bring their lunch. The morning and afternoon snacks are provided by the licensee. The children are served 1% milk. LPA observed snack menus posted. The parents are provided a copy of the menu. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. The children use personal drinking water bottles with their names. LPA inspected the restrooms. The toilets and sinks are functioning properly.

Children are inspected for illnesses as they arrive. A review of medication policy indicated that medication is administered with parents permission and doctor's authorization. The administered medication is documented on a separate sheet. There is a separate area for isolation and care of ill children in the director's office
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ST. JOHN'S LUTHERAN CHURCH NURSERY SCHOOL
FACILITY NUMBER: 191602269
VISIT DATE: 03/18/2025
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LPA inspected the very large outdoor play space and age appropriate toys. The outdoor equipment was inspected for health, safety, cushioning material, good material, and age appropriateness. Playground 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. Areas around high climbing equipment, and slides have cushioning material to absorb falls. There is a shaded area. The drinking water is taken outside daily.The facility is free of flies, insects and rodents. There are no bodies of water on the premises.

Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

Teacher child ratios were observed and staff names recorded. All staff members are fingerprint cleared. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Staff were questioned to establish their familiarity of emergency reporting requirements, emergency disaster plans and other site operations. Personal rights of children were discussed. Director states they use redirection. A fire drill or earthquake drill will be held once a month and logged. Staff were reminded children are to be supervised at all times.



Each child is signed in manually. The children are not transported off the premises for field trips.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ST. JOHN'S LUTHERAN CHURCH NURSERY SCHOOL
FACILITY NUMBER: 191602269
VISIT DATE: 03/18/2025
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Children and staff records were reviewed which are complete. The staff have current CPR/first aid certification. The staff have required immunization records. LPA reviewed records and there are at least 3 staff that do not have completed the Mandated Child Abuse Training. Additional forms and child care updates may be obtained at the department's website www.ccld.ca.gov.

The director is aware of Incidental Medical Services (IMS). The director has submitted a plan of operation to the department. There is one child receiving these services as needed. The medication is kept inside the classroom inaccessible to the children. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, Guardian for prints, Lead Poisoning Facts, Forms and Regulations. The licensee is signed up to receive the P.I.N.S.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Exit interview conducted. A copy of the report was read and provided to the director.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/18/2025 10:37 PM - It Cannot Be Edited


Created By: Veronica Wheatley On 03/18/2025 at 01:53 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: ST. JOHN'S LUTHERAN CHURCH NURSERY SCHOOL
FACILITY NUMBER: 191602269

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025

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
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Based on LPA observation and record review, the licensee did not comply with the section cited above in that LPA observed at least 3 staff members without the required Mandated Reporter Training this poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2025
Plan of Correction
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The director will have the staff complete the Mandated Reporter training and submit by 3/25/25 to the CCL Department.
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:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


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