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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004603
Report Date: 03/19/2021
Date Signed: 03/19/2021 12:40:21 PM

Document Has Been Signed on 03/19/2021 12:40 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:TRINITY LUTHERAN PRESCHOOLFACILITY NUMBER:
414004603
ADMINISTRATOR:CORPUZ, ANGELINAFACILITY TYPE:
850
ADDRESS:1248 BALBOA AVENUETELEPHONE:
(650) 580-2349
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 17TOTAL ENROLLED CHILDREN: 0CENSUS: 15DATE:
03/19/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jeff SchufreiderTIME COMPLETED:
12:45 PM
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Due to the COVID-19 health crisis and state, local county orders, a tele-inspection was conducted. Licensing Program Analyst (LPA) Van met with Pastor Jeff Schufreider for case management via Facetime. The Department received an application from the facility requesting a capacity increase. The facility operates on the Trinity Lutheran Church's ground. Currently, the facility is licensed for 17 preschool-age children and requesting an increase to the capacity of 26 preschool-age children. Present, there are fifteen children in care at the facility.

Through FaceTime video chat, LPA and Mr. Schufreider inspected the new classroom for Health and Safety Hazards. No changes were made to the previously licensed indoor spaces or outdoor play spaces. According to Mr. Schufreider, the new classroom was previously a staff's lounge. The facility decided to convert it into a classroom. Due to the inspection being done virtually, Mr. Schufreider measures the new classroom. The new classroom measures 308 square feet allowing for 9 children. The classroom appears clean and in good repair with sufficient lighting and ventilation. All furnishing and equipment are observed to be in good condition, and there are cubbies available for children's belongings. There is a total of 2 toilets and a urinal, allowing for 45 children; a total of 2 sinks, allowing for a capacity of 30 children.

The facility currently has an outdoor waiver approved by the Department from the previous Pre-Licensing, that allowed the facility to share the outdoor play area with the Preschool that is currently licensed by the Church (414002946). The outdoor spaces were previously measured and were 6059 square feet allowing for a capacity of 80 children.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2021
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: TRINITY LUTHERAN PRESCHOOL
FACILITY NUMBER: 414004603
VISIT DATE: 03/19/2021
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LPA discussed with Mr. Schufreider the new Director's paperwork and qualification. Mr. Schufreider stated he would have the new Director sends the paperwork to Licensing Office.

This report was emailed to Mr. Schufreider. Mr. Schufreider was advised that a follow-up inspection will be conducted in the future, and the measurement of indoor and outdoor space may be required.

The facility is recommended for a capacity increase to 26 preschool-age once the Fire Department approves fire Clearance.

This report will be kept in the facility file and made available for public review upon request. Desk duty is available Monday - Friday, 8:00am- 5:00pm. (650) 266-8800. Website for forms and regulations: www.cdss.ca.gov.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
LIC809 (FAS) - (06/04)
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