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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300603950
Report Date: 01/31/2025
Date Signed: 01/31/2025 04:11:04 PM

Document Has Been Signed on 01/31/2025 04:11 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:HARBOR TRINITY PRESCHOOLFACILITY NUMBER:
300603950
ADMINISTRATOR/
DIRECTOR:		ISSACSON, KRISTINAFACILITY TYPE:
850
ADDRESS:1230 BAKER STTELEPHONE:
(714) 556-4335
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 77DATE:
01/31/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Director, Kristina Issacson TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analysts (LPAs) D. Valdez Santana and A. Nunez conducted an on-site inspection for the purpose of a Case Management inspection on 1/31/2025. LPAs toured the facility inside and outside, census was taken, there were 77 children present upon arrival and 10 staff. Today's Case Management inspection is being conducted in response to a self-reported incident, reported to the Regional Office on 1/13/25, detailing a lead teacher miscounted and allowed to staff to leave, leaving the facility out of ratio by one child for approximately 45 minutes.

During the inspection, LPAs interviewed 4 staff involved in the incident. Through staff interviews Staff #1 (S1) stated Staff #2 (S2) miscounted and mistakenly dismissed 2 staff prematurely, dismissing them at 4pm. Typically if there is still a lot of kids in the afternoon, staff will be asked to stay to maintain ratios. That day staff were not asked to stay, and the two staff left. S2 thought staff were within ratios did not realize since S2 miscounted. S2 disclosed by 3:20pm, all classes come to the yard and S2 asks the teachers how many children they have and note it. S2 would compare what staff told S2 with the master list. S2 stated S2 double checks the ipad, to ensure it all matches. That particular day there were new students and parents, S2 had to verify the I.D.s and it was during that transition, that S2 lost track. Staff #3 (S3) stated it was time for Staff #4 (S4) to go home, maybe about 4pm. Staff relieved S4 and S3 believes that is when staff were out of ratio. S4 stated S4 was dismissed at 4pm and left with the understanding that staff were within ratio. S4 found out later that staff had gone over ratio.

Based on the gathered information, the facility is in violation and being cited for one Type A Limitations on Capacity CCR Section 101161(a). This is an immediate health and safety and personal rights risk to the children in care. See deficiency observed and cited on LIC 809D. Please refer to attached documentation of deficiency.



LPA Valdez Santana informed facility representative, that this report dated 1/31/2025 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Page 1 of 1.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HARBOR TRINITY PRESCHOOL
FACILITY NUMBER: 300603950
VISIT DATE: 01/31/2025
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LPA Valdez Santana also informed the facility representative to provide a copy of this licensing report dated 1/31/2025, that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted. The Notice of Site Visit was posted for no less than 30 consecutive days. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.



Page 2 of 2. End of Report.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/31/2025 04:11 PM - It Cannot Be Edited


Created By: Dianna ValdezSantana On 01/31/2025 at 03:36 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: HARBOR TRINITY PRESCHOOL
FACILITY NUMBER: 300603950

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/03/2025
Section Cited
CCR
101161(a)

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101161(a) Limitations on Capacity: A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This requirement was not met as evidenced by:
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Director stated a new lead was assigned to the afternoon shift, a staff email was sent out reminding staff of their roles, responsibilities and protocols. Director will email LPA Valdez Santana at dianna.valdezsantana@dss.ca.gov by POC due date.
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Based on LPAs' interviews 3 out of 4 staff disclosed staff were out of ratio due to miscounting therefore dismissing two staff prematurely. This poses an immediate risk to the health and safety 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:Martha Malane
LICENSING EVALUATOR NAME:Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2025


LIC809 (FAS) - (06/04)
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