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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304270029
Report Date: 09/15/2025
Date Signed: 09/15/2025 02:42:18 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/23/2025 and conducted by Evaluator Patricia Duron
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20250623145741
FACILITY NAME:CAPO BEACH CHURCH PRESCHOOLFACILITY NUMBER:
304270029
ADMINISTRATOR:WOLF, JORDANFACILITY TYPE:
850
ADDRESS:25975 DOMINGO AVE. RMS.7,8,9TELEPHONE:
(949) 443-1316
CITY:CAPISTRANO BEACHSTATE: CAZIP CODE:
92624
CAPACITY:50CENSUS: 23DATE:
09/15/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Wolf, Jordan, Director TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Uncleared staff are providing care and supervision to day care children in care.
Licensee is operating beyond the scope of their license
INVESTIGATION FINDINGS:
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On 09/15/25 at 9:30 AM, Licensing Program Analyst (LPA) Duron conducted an unannounced complaint visit to deliver the complaint findings for above allegations. This is a continuation of the investigation initiated on 6/27/25, LPA met with Director Jordan Wolf and informed them of the purpose of the visit. The Director guided LPA on a tour of the facility and census was taken. The overall census observed was 23 preschool children with 4 staff members.
A review of the Facility Report Summary on this date 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 inspection the facility was operating within facility's licensed capacity and within compliance of staffing ratios.
On 06/23/2025, the Orange County Child Care Office received a complaint alleging: (1) Uncleared staff are providing care and supervision to day care children in care. (2) Licensee is operating beyond the scope of their license. Reporting Party (RP) stated, Director did not ask about staff’s background check clearance until March 10, 2025. RP added they feel the Director doesn't check for staff background Page 1 of 3
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 8
Control Number 06-CC-20250623145741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CAPO BEACH CHURCH PRESCHOOL
FACILITY NUMBER: 304270029
VISIT DATE: 09/15/2025
NARRATIVE
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*This is an amended report to update information*

clearances and let staff work at the facility. RP stated, C1 who has been attending this facility for the last several weeks but C1 is not two years old yet.



During the course of investigation, LPA toured that facility, reviewed the facility’s Parent Handbook and reviewed records including C1’s Identification and emergency information (LIC700) and Licensing Information System (LIS) facility profile for CAPO beach church preschool, LPA conducted interviews with reporting party (RP), 3 staff members, 4 children, 4 parents and reviewed records.

Regarding allegation (1) Uncleared staff are providing care and supervision to day care children in care.

LPA interviewed 3 staff, one out of the 3 staff stated, Alyssa Kosky was not associated with facility and has been working at the facility since February 2025. 2 out of 3 staff interviewed, stated Alyssa Kosky was employed at the facility and was working with children. Director stated, Heather Watson has been working at the facility since 6/1/25. LPA reviewed the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions with the exception of Alyssa Kosky and Heather Watson were not associated to the facility.

Regarding allegation (2) Licensee is operating beyond the scope of their license.



LPA interviewed 3 staff, 3 out of 3 staff stated facility is operating beyond the scope of their license due to Child #1 (C1) is under 2 years of age and is enrolled in the program. S1 stated, the Director thought it would be ok, since C1 has a sibling enrolled in and it's summer and C1 will turn 2 by the beginning of the new school year. S1 confirmed C1’s date of birth, and it was determined C1 was under the age of 2 years old. LPA reviewed C1’s Identification and emergency information (LIC700) and it was determined C1 was under the age of 2 years old.

LPA Duron interviewed 4 children. 4 out of 4 children interviewed stated, Alyssa Kosky is a teacher at the facility. 2 out of 4 children interviewed stated, Heather Watson is a teacher at the facility.

LPA Duron interviewed 4 parents. All interviewed parents stated they did not have any concern with facility.


Page 2 of 3

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 06-CC-20250623145741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CAPO BEACH CHURCH PRESCHOOL
FACILITY NUMBER: 304270029
VISIT DATE: 09/15/2025
NARRATIVE
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*This is an amended report to update information*

Based on LPA’s interviews, the preponderance of evidence standard has been met, therefore the above allegations have been found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1 Section 102370(d)(1) Criminal Record Clearance and 101161(a) Limitations on Capacity. Please refer to attached 9099D for documentation of deficiencies.

9090D:


This requirement is met as evidence by: Based on LPA’s interviews and record review, Director informed LPA Alyssa Kosky had been working at the facility since February 2025, Director stated Alyssa Kosky was interviewed on 2/25/25 and only shadowed the Director on this date and Heather Watson has been working at the facility since June 2025, which poses an immediate health and safety risk to the children in care.

Based on LPA’s interviews and record review, it has been determined that C1 was enrolled in the preschool program before the age of 2, which posed a potential health and safety risk to the children in care.

LPA Duron informed Director, Jordan Wolf that this report dated 09/15/25 document 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.

LPA Duron informed the Director, Jordan Wolf to provide a copy of this licensing report dated 9/15/25 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.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were provided. The facility representative was provided a copy of their appeal rights 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. Any proposed changes to the physical plant, including telephone number, shall be immediately reported to the Department.



The facility representative 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 3 of 3. End of Report.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 06-CC-20250623145741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CAPO BEACH CHURCH PRESCHOOL
FACILITY NUMBER: 304270029
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/15/2025
Section Cited
CCR
102370(d)(1)
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102370(d)(1) Criminal Record Clearance. (d)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing... (1) Obtain a California clearance...
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Director has affiliated all staff memmbers present and LPA confirmed all staff members presentt are affiliated to facility at the time of visit. Director provided a written statement stating she will affiliate all staff members before allowing staff members to work at the facility.
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This requirement is not met as evidenced by: Based on LPA’s interviews and record review, Director informed LPA Alyssa Kosky has been working at the facility since February 2025 and Heather Watson has been working at the facility since June 2025, which poses an immediate health and safety risk to the children in care.
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Type B
09/15/2025
Section Cited
CCR
101161(a)
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101161(a) Limitations on Capacity
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
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Director provided a written statement stating she will not enroll children until they are 2 years old. LPA reviewed roster and confirmed all children enrolled are 2 years old or older.
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This requirement is not met as evidenced by: Based on LPA’s interviews and record review, it has been determined that C1 was enrolled in the preschool program before the age of 2, which posed a potential health and safety risk to the children in care.
*This is an amended report to update information*
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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.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/23/2025 and conducted by Evaluator Patricia Duron
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20250623145741

FACILITY NAME:CAPO BEACH CHURCH PRESCHOOLFACILITY NUMBER:
304270029
ADMINISTRATOR:WOLF, JORDANFACILITY TYPE:
850
ADDRESS:25975 DOMINGO AVE. RMS.7,8,9TELEPHONE:
(949) 443-1316
CITY:CAPISTRANO BEACHSTATE: CAZIP CODE:
92624
CAPACITY:50CENSUS: 23DATE:
09/15/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Wolf, Jordan, Director TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Licensee discourages staff from filing incident reports as required
Facility Director is not on premises the required amount of time
Licensee retained a day care child in care with obvious signs of illness
Licensee does not ensure that day care children are provided a safe environment while in care
Staff member engaged in inappropriate behavior with a day care child in care
INVESTIGATION FINDINGS:
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On 09/15/25 at 9:30 AM, Licensing Program Analyst (LPA) Duron conducted an unannounced complaint visit to deliver the complaint findings for above allegations. This is a continuation of the investigation initiated on 6/27/25, LPA met with Director, Jordan Wolf and informed them of the purpose of the visit. The Director guided LPA on a tour of the facility and census was taken. The overall census observed was 23 preschool children with 4 staff members.
A review of the Facility Report Summary on this date 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 inspection the facility was operating within facility's licensed capacity and within compliance of staffing ratios.
On 06/23/2025, the Orange County Child Care Office received a complaint alleging:
(1)Licensee discourages staff from filing incident reports as required, (2) Facility Director is not on premises the required amount of time, (3) Licensee retained a day care child in care with obvious signs of illness, (4) Licensee does not ensure that day care children are provided a safe environment while in care
Page 1 of 4
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 06-CC-20250623145741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CAPO BEACH CHURCH PRESCHOOL
FACILITY NUMBER: 304270029
VISIT DATE: 09/15/2025
NARRATIVE
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(5) Staff member engaged in inappropriate behavior with a day care child in care. Reporting Party (RP) stated S1 instructs staff not to report incidents. RP stated, Director is very rarely at the facility. RP stated, Director spends "maybe" 15 hours per week at the facility. RP stated, two weeks ago Child #5 (C5) was very sick and fevered. RP stated , the Director told staff that they would text the parents but went into a meeting instead. C5 stayed there sick and fevered for a long time. RP stated, S1 approached C5, who was crying and S1 told C5 to stop crying and threw a blanket over their face. RP stated, S1 told staff to remove the oil diffusers from the classrooms before licensing showed up.

During the course of investigation, LPA toured that facility, reviewed facility’s Parent Handbook and reviewed records including injury notifications via email. LPA conducted interviews with reporting party, 3 staff members, 4 children, 4 parents and reviewed records.

LPA reviewed documentation via email submitted by Director. On 6/13/25, the Director emailed Parent #1 (P1) regarding an incident that occurred during snack time. On 6/18/25, the Director emailed Parent #5 (P5) regarding illness status for Child #5 (C5). On 6/19/2025, the Director emailed Parent #4 (P4) regarding an incident that occurred at the facility. On 6/27/25, the Director emailed Parent #1 (P1) regarding Child #1 (C1) enrollment to program.

Regarding allegation (1) Licensee discourages staff from filing incident reports as required

LPA interviewed 3 staff members. 3 out of 3 staff members stated they have not witnessed a license or director discouraging staff from filing incident reports as required. Staff #1 (S1) stated, staff inform the parents, the director will send emails to both parents and let them know what happened If it is severe the Director will immediately call and parent's will pick up their child. Staff let the parents know if their child gets hurt or is sick, and parents will sometimes pick up if it is needed or if it is minor, the child will remain at school until pick up.

Regarding allegation (2) Facility Director is not on premises the required amount of time

LPA interviewed 3 staff members. 3 out of 3 staff members stated they have not witnessed the facility director not on premises for the required amount of time. Staff #2 (S2) stated, “Director is always here”; the Director opens around 8 am during school year and 8:30am for summer, the Director is here until 5pm. Staff #3 (S3) stated, the Director is here every day, but not necessarily in the classroom yet nearby, she is in the office or in the church area. Page 2 of 4
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 06-CC-20250623145741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CAPO BEACH CHURCH PRESCHOOL
FACILITY NUMBER: 304270029
VISIT DATE: 09/15/2025
NARRATIVE
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Regarding allegation (3) Licensee retained a day care child in care with obvious signs of illness

LPA interviewed 3 staff members. 3 out of 3 staff members stated they have not witnessed licensee retaining a day care child in care with obvious signs of illness. S2 stated, the director will call the parents and parents will pick up their child. Staff make sure to keep the child separate from the other children, they will be in the classroom with the teacher or in the office with the director.

Regarding allegation (4) Licensee does not ensure that day care children are provided a safe environment while in care

LPA interviewed 3 staff members. 3 out of 3 staff members stated they have not witnessed licensee or director not ensuring that day care children are provided a safe environment while in care. Staff #1 (S1) stated, the environment is safe, the facility has cameras, locks and staff provide 100% supervision. S3 stated, the environment is safe, all the staff are very good with the children. Staff keep the children safe and the classrooms and playground safe too.

Regarding allegation (5) Staff member engaged in inappropriate behavior with a day care child in care
LPA interviewed 3 staff members.

3 out of 3 staff members stated they have not witnessed staff member engage in inappropriate behavior with a day care child in care. Staff #1 (S1) stated, sometimes staff cover the children with their blanket if a child may need help or assistance but staff never purposely cover the child’s head but when staff lift the blanket and place it down to cover the child, it could cover their head a little. But the child or teacher moves the blanket down from their face.

LPA Duron interviewed 4 children. The 4 children interviewed made no disclosures regarding the above allegations. LPA Duron interviewed 4 parents. All interviewed parents stated they did not have any concern with facility.

Page 3 of 4
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 06-CC-20250623145741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CAPO BEACH CHURCH PRESCHOOL
FACILITY NUMBER: 304270029
VISIT DATE: 09/15/2025
NARRATIVE
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Based on the information gathered from LPAs’ interviews there are insufficient evidence to corroborate the allegations: (1)Licensee discourages staff from filing incident reports as required, (2) Facility Director is not on premises the required amount of time, (3) Licensee retained a day care child in care with obvious signs of illness, (4) Licensee does not ensure that day care children are provided a safe environment while in care and (5) Staff member engaged in inappropriate behavior with a day care child in care. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the allegation did or did not occur in the day care facility, therefore the allegations are UNSUBSTANTIATED.
An exit interview was completed. The report was reviewed and discussed. Appeal Rights were provided. The facility representative was provided with a copy of their appeal rights 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 facility representative 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 4 of 4. End of Report.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 8