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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600328
Report Date: 08/05/2024
Date Signed: 08/05/2024 04:12:16 PM

Document Has Been Signed on 08/05/2024 04:12 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SHORELINE CHRISTIAN PRESCHOOLFACILITY NUMBER:
300600328
ADMINISTRATOR/
DIRECTOR:		TOSCANO, MELIDAFACILITY TYPE:
850
ADDRESS:10350 ELLIS AVENUETELEPHONE:
(714) 962-6886
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 240TOTAL ENROLLED CHILDREN: 75CENSUS: 56DATE:
08/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Director, Melida ToscanoTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced case management inspection due to deficiencies discovered during staff interviews and physical plant inspection on 06/18/2024. Upon arrival LPA met with Director, Melida Toscano, who accompanied LPA on a tour of the facility. Census was taken as follow: 4 toddlers, 52 napping preschool children with 6 staff members. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

On 06/18/2024, during an inspection to the facility, and interviews with the staff, it was discovered that the facility did not report an unusual incident LIC624 to the Department. On 06/06/2024, a child fell and fractured their elbow. The incident was documented internally; however, there was no record of the facility reporting the incident to the Community Care Licensing Department.

On 06/18/2024, during an inspection to the facility, LPA observed the cushioning material of woodchips under and around the climbing equipment, slides and other similar equipment appeared to not be sufficient to absorbs falls.

Based on the interviews conducted with staff members, and a physical plant inspection, the following deficiencies are being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101212(d)(1)(B) Reporting Requirement and 101238.2(e) Activity Space. The deficiencies are being cited on the attached 809D.


Exit interview was conducted with Director Melida Toscano. The Notice of Site Visit was posted. Director was informed that the Notice of Site Visit must be posted for 30 consecutive days. The Director was provided with a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2024
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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Document Has Been Signed on 08/05/2024 04:12 PM - It Cannot Be Edited


Created By: Cindy Nguyen On 08/05/2024 at 03:25 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SHORELINE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300600328

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2024
Section Cited
CCR
101212(d)(1)(B)

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101212(d)(1)(B) Reporting Requirements (d) Upon the occurrence, during the operation...(d)(2) below shall be submitted to the Department ... (1) Events.. (B) Any injury to any child that requires medical treatment. This requirement is not met as evidenced by:
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Director states they will follow licensing procedures to submit future incident reports. Director will also train staff (listed as designees of responsibility) of protocol and email LPA training sheet and attendance sheet by POC date.
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Based on LPA interview with the staff members on 06/18/2024, a child suffered a broken elbow due to a fall. Facility documented the incident but did not report it to the local licensing agency, which is a potential risk to the health, safety, or personal rights of the children in care.
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Type B
08/05/2024
Section Cited
CCR101238.2(e)

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101238. 2(e) Outdoor Activity Space
(e) As a condition of licensure, the areas around and under high climbing equipment...that absorbs falls. (1) Sand, woodchips and pea gravel, or rubber mats... This requirement was not met:
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During today's inspection, LPA observed new woodchips under and around the climbing equipment, slides and other similar equipment.
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Based on observation the cushioning material of woodchips under and around the climbing equipment, slides and other similar equipment appeared to not be sufficient to absorbs falls. This poses a potential risk to the health, safety or personal rights risk to the persons in care.
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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:Patricia Magana
LICENSING EVALUATOR NAME:Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2024


LIC809 (FAS) - (06/04)
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