<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607110
Report Date: 10/24/2024
Date Signed: 10/24/2024 03:38:57 PM

Document Has Been Signed on 10/24/2024 03:38 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:LIBERTY CHRISTIAN PRESCHOOLFACILITY NUMBER:
300607110
ADMINISTRATOR/
DIRECTOR:		KEITH, REGINAFACILITY TYPE:
850
ADDRESS:7661 WARNER AVENUETELEPHONE:
(714) 841-3816
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 117TOTAL ENROLLED CHILDREN: 117CENSUS: 43DATE:
10/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Director, Regina KeithTIME VISIT/
INSPECTION COMPLETED:
03:45 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
Licensing Program Analysts (LPA) Cynthia Sun conducted an unannounced case management inspection in response to a self-report Unusual Incident dated 10/18/2024. LPA met with Director, Regina Keith. Census was taken as follows: 1 staff supervising 11 preschool children in Room #105, 2 staff supervising 11 preschool children in room #4, 2 staff supervising 14 preschool children in room #5, and 1 staff supervising 7 children in room #1.

A review of staff criminal clearance records 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.

On 10/18/24, Regional Office received a self reported Unusual Incident Report (UIR) stating Child #1 (C1)’s arm at elbow was dislocated. Staff #2 (S2) stated Staff #1 (S1) was holding C1 hand and holding C1 to stand when C1 resisted and dropped body to the floor. S1 moved C1 so C1 would not continue to be pushed by C2. On 10/18/24 at 9:02 AM C1's parents informed facility that C1 had nursemaids’ elbow, arm was relocated and C1 feels better. C1 is expected to be back to the program the week of 10/21/24.

During today's inspection, LPA inspected facility, interviewed staff and children, obtained video recording of incident and obtained facility children and staff rosters.

Due to insufficient information available at this time, the reported incident needs further investigation.



PAGE 1 OUT OF 2


SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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 2
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: LIBERTY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300607110
VISIT DATE: 10/24/2024
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
26
27
28
29
30
31
32
No deficiency was observed during today's inspection.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days. The director was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The 'Notice of Site Visit' must be posted on or adjacent to the door.


PAGE 2 OUT OF 2

End of Report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2