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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300603522
Report Date: 04/26/2023
Date Signed: 04/26/2023 02:46:42 PM

Document Has Been Signed on 04/26/2023 02:46 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:GRACE HARBOR CHURCH AND SCHOOLFACILITY NUMBER:
300603522
ADMINISTRATOR:REBEKAH BAYFACILITY TYPE:
850
ADDRESS:12881 NEWPORT AVENUETELEPHONE:
(714) 544-4431
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 78TOTAL ENROLLED CHILDREN: 78CENSUS: 57DATE:
04/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Rebekah Bay, DirectorTIME COMPLETED:
01:45 PM
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On 04/26/2023, Licensing Program Analysts (LPA) Tran and Chan conducted a case management visit to amend a report that was completed on 04/06/2023. LPAs met with the Director Rebekah Bay and informed the Director of the purpose of the visit. A tour of the facility was conducted, and a census was taken. Observed at the time of the visit was a total of 57 children supervised by 5 staff in 3 different classrooms.

A review of the Facility Personnel Report Summary on 04/26/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today's visit, LPA provided the amended report to the Director.

No deficiency was observed during this visit.

Exit interview was conducted. The Notice of Site Visit was posted. Director was advised the Notice of Site Visit must be posted for 30 days or 100$ Civil Penalty will be assessed.

(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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