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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606476
Report Date: 03/09/2023
Date Signed: 03/09/2023 02:57:09 PM

Document Has Been Signed on 03/09/2023 02:57 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:
300606476
ADMINISTRATOR:REBEKAH BAYFACILITY TYPE:
830
ADDRESS:12881 NEWPORT AVENUETELEPHONE:
(714) 544-4431
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 16TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
03/09/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Rebakah Bay, directorTIME COMPLETED:
01:00 PM
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On 03/09/2023 Licensing Program Analysts (LPAs) Stella Gutierrez and Anna Chan made an unannounced visit to the facility for the purpose of a case management to observe the facility is within substantial compliance in accordance to title 22 regulation and Health and Safety Code standards. Upon arrival LPAs were met by Rebekah Bay, director who was explained the reason for today's visit. LPAs were provided a tour of the facility inside and out. LPAs observed 04 infant staff and 12 infants in care. All staff present today are with criminal records clearance and associated to the facility.

During todays inspection LPAs observed the infant changing pad on the changing table to be above the 3 inch sides. The director stated that these changing pads have been the same type for the past 11 years. During today LPAs observed the changing pad to be changed to a new one that does not rise above the 3 inch sides. The director stated that she will purchase additional changing pads to place on the remainder of the changing table. Before and after picture taken today.

The facility director was reminded to ensure the health and safety of the children in care and to report any unusual incidents to their local licensing office if any occur. The director will forward LPAs additional pictures by 03/10/2023 of the changing pads via text.

Based on LPAs observations there will be no citations issued today.
Exit interview conducted and report was reviewed with the Rebekah Bay, director. Appeal Rights were discussed. . The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Page 1 of 1
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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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