300605383-8-30-2023-06-CC-MMAK-CV7Q43-20230830114939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300605383
Report Date: 08/30/2023
Date Signed: 08/30/2023 11:49:48 AM

Document Has Been Signed on 08/30/2023 11:49 AM - 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	IMMANUEL EVANGELICAL LUTHERAN CHURCH AND SCHOOL		FACILITY NUMBER:	300605383
ADMINISTRATOR:	ROHM, KRISTINE		FACILITY TYPE:	850
ADDRESS:	147 S. PINE		TELEPHONE:	(714) 538-2374
CITY:	ORANGE	STATE: CA	ZIP CODE:	92866
CAPACITY: 44	TOTAL ENROLLED CHILDREN: 44	CENSUS: 0	DATE:	08/30/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Director		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Page 1 of 4 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek and LPA Mila Quinto conducted a case management inspection of the facility for the purpose of the facility increasing their capacity from 44 to 75 preschool children by adding Room # 1 to the existing classrooms. LPAs met with director, Kristine Rohm who gave LPAs a tour of the facility. The facility is located on the ground of Immanuel Evangelical Lutheran Church. They are currently licensed for 44 children in rooms 3, 5, and 6. There were no children present today. Staff were working on the classrooms to get ready for new school year. The facility has requested to provide care and supervision to 75 preschool children ages 3 to 6 years, Monday to Friday from 8:30 am to 11:30 am from September to May and Tuesday, Wednesday and Thursday 8:30 to 11:30 am from June to August of each year. Parents sign in and out their children manually in front of the classrooms. A review of the Facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This is a half day program. Parents provide morning snack for their children. All areas identified on the Facility Sketch were inspected. If children become ill during the day, they will rest in the director's office, and use the adult restroom if needed until sick children are picked up. Facility met all the licensing posting requirements. Following was observed in all the rooms: Age appropriate furniture and activities including educational, arts & crafts items. Rooms are well ventilated with proper lighting and shade. Continued on page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IMMANUEL EVANGELICAL LUTHERAN CHURCH AND SCHOOL	FACILITY NUMBER: 300605383
	VISIT DATE: 08/30/2023

NARRATIVE

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There is carbon monoxide in each classrooms.

The measurement of the rooms according to updated numbers are as below:
Room 1 is:762.19 square feet
Room 3 is: 1156 square feet
Room 5 is: 751.40 square feet
Room 6 is: 751.40 square feet
Total indoor measurement for the rooms are 3420 square feet divided by 35 square feet = 97.74
(98 children)

Toilets: 7 X 15= 105 children
Sinks: 10 X 15 = 150 children.
There is one sink in each classroom. The restrooms are located outside the classrooms. The director was reminded that children shall be escorted to and from the restrooms by an adult.

Outdoor Activity Space:
Total measurement of the outdoor space is: 7889.80 square feet divided by 75 square feet=105.19
(105 children). This play yard measurement is for the play yard in the back of the classrooms. There is chicken coop on this playground which is separately fenced off. There is a garden area for children's gardening. There is art studio located on this playground area. There are two exit gates on this playground which are locked at all times and they are not used for entrance and exit purposes.
There is also additional outdoor space (courtyard) which is for children's bike riding and other activities. The court yard is all fenced. The court yard and sport field were not measured since the playground on the back of the classrooms are enough to cover the requested capacity.
Outdoor spaced is completely enclosed. Outdoor activity area is supplied with age and size appropriate equipment with adequate of cushioning materials such as wood chips under climbing structure and slide. On the court yard there is a climbing structure for older children which is separately fenced off. According to
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IMMANUEL EVANGELICAL LUTHERAN CHURCH AND SCHOOL	FACILITY NUMBER: 300605383
	VISIT DATE: 08/30/2023

NARRATIVE

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director this structure will be removed. There are swings on this playground that children use. Shade is provided by trees, umbrella, and wooden patio structure. There are gates installed in front of the stairs to prevent children accessibility to second floor.

LPA gave a copy of the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. The director's Immunization, Mandated Reporter Training, Health and Safety Training are current. Her CPR and 1st aid is EMSA approved and expires 9/28/2023.

The director, Kristine Rohm reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (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.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IMMANUEL EVANGELICAL LUTHERAN CHURCH AND SCHOOL	FACILITY NUMBER: 300605383
	VISIT DATE: 08/30/2023

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To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care- licensing/subscribe and select the Child Care option to receive email communication. Exit interview conducted and report was reviewed with the director, Kristine Rohm.

Fire clearance approval has been received in our office to approve the capacity of 75 children.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Based on today’s measurements, the sinks and toilets availability, the request of the facility for increasing capacity to 75 preschool children in rooms 1, 3, 5, and 6 will be final reviewed and discussed with management in the Regional Office. The facility will be notified if any additional information is required.

Updated LIC 500, LIC 308, and LIC 610 were submitted to LPAs on today's date.

End of report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

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