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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300602390
Report Date: 02/09/2022
Date Signed: 02/09/2022 01:02:26 PM

Document Has Been Signed on 02/09/2022 01:02 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:MESSIAH LUTHERAN PRESCHOOLFACILITY NUMBER:
300602390
ADMINISTRATOR:SWANSON, DONNAFACILITY TYPE:
850
ADDRESS:4861 LIVERPOOLTELEPHONE:
(714) 528-8632
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 106DATE:
02/09/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Administrator Ms. Swanson, Donna TIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Desai, Ketki conducted an unannounced Case Management Licensee initiated inspection for a change in capacity, Increasing the capacity for Preschool children.

Currently facility is licensed for 120 Preschool age children (2.6 to 6 years old) in the 9 designated classrooms.

Licensee is now requesting a change to the current Preschool capacity to 129 children, there is no change in the 9 designated classrooms.

LPA met with Facility Administrator Ms. Swanson, Donna M who gave a tour of all the 9 preschool rooms including the outdoor play yard.

All areas identified on the facility sketch were inspected and measured. LPA observed the following in the preschool classrooms.



Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with sink, toilet, were inspected.
Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. First Aid supplies were inventoried.
There are toilets in-between 4 classrooms and they are shared; each classroom has 2 sinks inside the classroom and the sink is reachable to the children.
Facility has the required postings posted and have completed the disaster drills in the last quarter. (1/25/2022)

Staff providing care and supervision have obtained the required clearances and transfers. (1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MESSIAH LUTHERAN PRESCHOOL
FACILITY NUMBER: 300602390
VISIT DATE: 02/09/2022
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All the nine rooms were measured on today’s inspection

Classrooms LengthWidth
Area
Encumbered
Space
Room # 101
33.83
17.67
597.78
7.87
589.91
Room # 103
38
22.42
851.96
16.50
835.46
Room # 105
33.92
19.92
675.68
16.50
659.18
Room # 107
42.75
17.75
758.81
3.92
754.89
Room # 109
42.5
17.92
761.60
3.92
757.68
Room # 111
37.92
22.5
853.20
20.42
832.78
Room # 113
32.92
28.67
943.81
72.75
871.06
Room # 121
27.42
25.25
692.35
20.42
671.93
Room # 123
22.75
22.83
519.38
3.92
515.46

Total indoor activity space: 6488’35 divided by 35 = 185’38 (185 children)

Total sinks & Toilets: Sinks: 28 X 15 = 420 / Toilets: 10 X 15 = 150

Facility has enough indoor activity space along with sinks and toilets to accommodate the requested capacity.

Outdoor yard: Facility has designated yard surrounding the classrooms. The Preschool play yard is completely enclosed by a fence. Outdoor activity area is supplied with age and size appropriate equipment including a climbing structure. An adequate amount of cushioning material (soft cushion) is in place under the equipment. Shade is provided by awnings and a Water pitcher and personnel water bottles are used for drinking water. Additional tables and benches are also placed under the shade for outdoor tabletop activities including lunch activity. The yard has partial grass and concrete flooring. Bike trail is surrounding the climbing structure Play yard is accessible from each of the classrooms.

(Page 2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MESSIAH LUTHERAN PRESCHOOL
FACILITY NUMBER: 300602390
VISIT DATE: 02/09/2022
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Outdoor measurements:

Outdoor play yard LengthWidth
Area
Encumbered
Space
Climbing / bike trail
81.5
73.33
5976.39
5976.39
Shaded activity area
57
38
2166.00
2166.00

Total outdoor activity area: 8142’39 divided by 75 = 108.57 (109 children)

Outdoor measurement is the limiting factor for the capacity requested.

Facility shall request a Waiver for a rotating schedule between the nine preschool classrooms.

Based on today’s inspection with Indoor / Outdoor measurements, Sink and Toilet availability, facility has enough space only to accommodate 129 Preschool age children in the assigned nine rooms. Limiting factor is the outdoor space.

Administrator Ms. Swanson, Donna has provided the copy of the current CPR / First Aid training (6/2023).

Fire clearance approval has been received from Orange county Fire Authority approving the requested capacity of 129 children in the designated 9 classrooms.

License shall be granted after the final approval by the management.

129 Preschool children ages (2.6 years to 6 years old) in Room # 101/ 103/ 105/107/ 109/ 111/ 113/121 and 123. Monday to Friday 7:00 AM to 5:30 PM.
Facility shall submit a Waiver request for rotating schedule for outdoor activities.

Report was read to the Facility Administrator; appeal rights were provided and Notice of Site visit was posted.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC809 (FAS) - (06/04)
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