<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495108
Report Date: 09/23/2022
Date Signed: 09/23/2022 01:21:08 PM

Document Has Been Signed on 09/23/2022 01:21 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:GOOD SHEPHERD'S FOLD PRESCHOOLFACILITY NUMBER:
197495108
ADMINISTRATOR:ZURBRUGG, PHIL E.FACILITY TYPE:
850
ADDRESS:1350 W. 25TH STREETTELEPHONE:
(310) 833-3340
CITY:SAN PEDROSTATE: CAZIP CODE:
90732
CAPACITY: 60TOTAL ENROLLED CHILDREN: 31CENSUS: 21DATE:
09/23/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:38 AM
MET WITH:Phil Zurbrugg-Representative and Maria Valin-lead teacherTIME COMPLETED:
01:24 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 9/23/2022 Licensing Program Analyst (LPA)made an announced visit to the Good Shepherds Fold Preschool for the purpose of conducting a pre-licensing inspection. The center is located on the Good Shepherd Evangelical Lutheran Church of San Pedro. LPA met with Phil Zurbrugg -Representative and Maria Valin- lead teacher The applicant is will be providing continuing care from the previous licensee. The applicant is requesting a capacity of 60 day care children ages 2 years - until entry into first grade. There are three classrooms dedicated to the day care program (two classrooms and partial use of the churches sanctuary (there is a sliding partition, children have no access to the sanctuary). During todays inspection LPA observed care and supervision of 21 children, class rooms were within ratio. There is an approved fire clearance on file conducted by Inspector Henry Medina of the L.A. City Fire Department: Institution Unit

The following was observed:

INDOOR ACTIVITY SPACE

The classrooms were clean in good repair

Trash cans used for solid waste were observed with tight fitting lids

Fire extinguishers were 2AB10C or larger.

Carbon monoxide detectors were observed in

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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 5
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: GOOD SHEPHERD'S FOLD PRESCHOOL
FACILITY NUMBER: 197495108
VISIT DATE: 09/23/2022
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
26
27
28
29
30
31
32
Drinking water will be provided through filtered water dispensers

The facility has operable windows and central heating and cooling.Windows were in good repair free of chipping paint, dirt, insects or debris

Adequate lighting was observed

First aid kits were available with the required essentials: scissors, bandages, tweezers, and thermometer

Age appropriate equipment was observed in good repair

No Fireplaces or open face heaters were observed

Disinfectants and cleaning solution and other toxins or poisons were made inaccessible to children, placed in a locked cabinet or storage room

The office and the staff restroom will be used for isolation of ill children

The facility has working telephones in the classrooms

Parents and authorized adults will sign children in and out using an electronic the applicant was made aware that sign in sheets shall be made readily available upon the request of the department.

The required postings were posted in a common area for parents and visitors review

Children nap in the sanctuary class room using cots, cots were observed in good repair.

Measurements for the indoor activity space was 2342.07 divided by 35 SQ. FT. per child = 66

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: GOOD SHEPHERD'S FOLD PRESCHOOL
FACILITY NUMBER: 197495108
VISIT DATE: 09/23/2022
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
26
27
28
29
30
31
32
FOOD SERVICE:

Meals are provided by parents, the center provides snacks. Weekly menus were posted for review.

LPA observed a full kitchen that was inaccessible to children in care, the kitchen was clean refrigeration and storage for foods were observed. LPA did not observe any contaminated foods in this area

Center has devised an Incidental Medical Service plan

RESTROOMS

THERE WERE:

7 and 2 urinals toilets = 1 toilet per 15 children and 1 urinal per 2 toilets for a total of 150 children

8 sinks = 1 sink per 15 children for a total of 120 children

The restrooms were clean and sanitized with the necessary toiletries, sinks and toilets were operable and in good repair. Faucets delivered cold water.

OUTDOOR ACTIVITY SPACE

Age appropriate toys and equipment were observed in good condition.

The play yard gated with a 4 inch or higher gate.

No hazardous conditions or equipment was observed during today’s visit.

Resilient cushioning was observed under all climbing apparatus. Sand box was free of any hazardous materials

Children use their personal water bottles for drinking water

LPA observed a tent for shade and benches for resting.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: GOOD SHEPHERD'S FOLD PRESCHOOL
FACILITY NUMBER: 197495108
VISIT DATE: 09/23/2022
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
26
27
28
29
30
31
32
The playground has two levels the sandbox is located in the upper area

measurements for the outdoor activity area equaled 5621.73 divided by 75 square feet per child for capacity total of 74 preschool children.

Based on today’s inspection the facility shall be recommended for a capacity of 60 preschool children determined by the applicants requested capacity. The license will be pending approval of directors qualifications waiver or upon completion of required classes for Maria Valin.

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.

facility representative 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.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: GOOD SHEPHERD'S FOLD PRESCHOOL
FACILITY NUMBER: 197495108
VISIT DATE: 09/23/2022
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
26
27
28
29
30
31
32
LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative Maria Valin - lead teacher.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5