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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561708112
Report Date: 10/08/2021
Date Signed: 10/08/2021 01:35:22 PM

Document Has Been Signed on 10/08/2021 01:35 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:TRINITY LUTHERAN PRESCHOOLFACILITY NUMBER:
561708112
ADMINISTRATOR:KERRI LAUNERFACILITY TYPE:
850
ADDRESS:2949 ALAMO STREETTELEPHONE:
(805) 526-5975
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 85TOTAL ENROLLED CHILDREN: 0CENSUS: 58DATE:
10/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Kerri LaunerTIME COMPLETED:
11:30 AM
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On October 8, 2021 at 10:30 AM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA met with facility Director Kerri Launer and advised the purpose of the inspection. Director Provided LPA a tour of the facility inside and out. There were 58 children in care at the time of the inspection. The center operates from 7:00 AM to 6:00 PM, Monday thru Friday. This is a combined center with an infant component.

LPA observed required licensing documents mounted on the wall in the office. The center does not have a snack/meal schedule. Children bring their own lunch and daily snacks from home. The center has four (4) classes available for use. Some of the classrooms have their own restroom. LPA observed the facility has enough toilets and sinks readily available for children in care. LPA did not observe any hazards/toxins items accessible to children in care. Each of the classrooms have age appropriate toys and furniture readily accessible. LPA observed required mediation properly secured and inaccessible to children in care. Facility provides children that are staying full day a sleeping cot during quiet time if they choose to sleep. The children bring their bedding from home. LPA observed the playground has age appropriate toys and structures available for children to use. The playground has ample amount of shade available. The facility has water available for children inside and out. Each classroom has their own water pitcher. The facility provides small Dixie cups for the children to drink water. Children's names are placed on the cup. LPA observed all staff and children wearing masks.

Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2021
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: TRINITY LUTHERAN PRESCHOOL
FACILITY NUMBER: 561708112
VISIT DATE: 10/08/2021
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A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. LPA observed staff files to be complete and current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Teachers meet the required qualifications. Teachers present have current Pediatric CPR/First-Aid and Mandated Reporter certificates. LPA spoke with Director about new Covid-19 guidelines. Facility is currently following Covid-19 guidelines.
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

No deficiencies were cited during today's inspection.



THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
LIC809 (FAS) - (06/04)
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