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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018931
Report Date: 03/12/2024
Date Signed: 03/12/2024 04:39:45 PM

Document Has Been Signed on 03/12/2024 04:39 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CONCORDIA LUTHERAN KING'S CLUBFACILITY NUMBER:
198018931
ADMINISTRATOR:SUSAN JENNINGSFACILITY TYPE:
840
ADDRESS:13633 183RD ST.TELEPHONE:
(562) 926-2491
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 30TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
03/12/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Elizabeth Medina TIME COMPLETED:
05:00 PM
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About 3:20 PM, Licensing Program Analyst (LPAs) T. Tran and C. Kam made an unannounced required inspection at the above licensed facility. Upon entering the facility, LPAs met with Center Director, Elizabeth Medina and we toured the facility inside and outside. LPA observed proper care and supervision.
This is a school age program providing care for before and after school children with preschool (191501048) program on the premises. Facility was licensed in room 3 and 23 and currently the facility is utilizing room 3 due to low enrollment. The facility hours of operation are (7:00 AM – 6:30 PM; Monday-Friday). The facility obtained current pediatric CPR and First Aid for all facility staff members. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.
LPA observed all posting requirements for operation on the posting board LIC 203A-License, LIC 610 A-Emergency Disaster Plan, LIC 9148-Earthquake Preparedness Check List, PUB 394-Notification of parent’s rights poster, LIC 613A- Personal Rights, PUB 269- Child Car Seat Law, Menus, and Activity Schedule.
LPA inspected the furniture and equipment for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. Individual storage for children's belongings and learning materials was observed. Isolation area located at the staff's space. Age-appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. Classroom have trash can with tight lids, first aid supplies, smoke detectors; carbon monoxide/fire extinguishers were observed. Per staff, the facility frequently cleaned and disinfected all high-touch surfaces, including toys and learning materials.
The facility provided snack. Kitchen/food preparation area observed to be clean with sufficient food supply and proper storage. Sign in and out sheet procedures were reviewed. The facility roster was up to date and fire and emergency disaster drills were conducted monthly. Emergency disaster plan is updated and reflected to the current operation. Children and staff records were reviewed and in good order. No children required IMS at this time.
Outdoor play area was inspected for free of hazards and inaccessibility to bodies of water. Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. Water is accessible indoor and outdoor by water bottles. Refilled water available by filtered water.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CONCORDIA LUTHERAN KING'S CLUB
FACILITY NUMBER: 198018931
VISIT DATE: 03/12/2024
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed 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
LPA recommended facility to stay updated with information related to Covid-19 from the California Department of Public Health (CDPH) guidelines, including Centers for Disease Control and Prevention (CDC) guidelines to help prevent and protect staff and children in care. LPA advised to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations and PINs. LPA informed the Child Care Advocate Program (CCAP) provide many other helpful resources to the licensees and the public. Visit www.cdss.ca.gov to receive important updates.
Licensee was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B). Licensee is reminded that smoking is prohibited on the premises.
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.
No deficiency was cited at this time. 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, Elizabeth Medina.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
LIC809 (FAS) - (06/04)
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