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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304270029
Report Date: 12/09/2025
Date Signed: 12/09/2025 10:20:44 AM

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
10/13/2025 and conducted by Evaluator Kathy Trinh
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20251013105602
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: 35DATE:
12/09/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director, Jordan WolfTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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Facility provides care for children that do not have immunization prior to admission
INVESTIGATION FINDINGS:
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On 12/09/2025, Licensing Program Analyst (LPA), K. Trinh, conducted an unannounced visit to the facility to deliver findings for a complaint that was received at the Orange County Regional Child Care Licensing Office. LPA met with Director, Jordan Wolf and explained the reason for the visit. LPA was led on a tour of the facility and observed a total of 35 children and 4 staff. A review of the Facility Personnel 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 its licensed capacity and within compliance of staffing ratios.

On 10/13/2025, the Orange County Regional Child Care Licensing Office received a complaint with the allegation that the facility is providing care for children that do not have immunizations prior to admission.
On 10/15/2025, LPA made an unannounced visit to the facility and interviewed five (5) staff.
(Continue to page 2)
Substantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Tina Nguyen
LICENSING EVALUATOR NAME: Kathy Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
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 5
Control Number 06-CC-20251013105602
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: 12/09/2025
NARRATIVE
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(Page 2)

Four out of five staff interviewed stated that they are not aware of the children’s immunization requirements upon enrollment. LPA reviewed a random sample of five (5) children’s files, it was found that Child 1 (C1) has attended the facility since April 2024 and Child 2 (C2) has attended the facility since September 2025. C1 and C2 did not have immunization records for review. LPA also verified that C1 and C2 do not have immunization exceptions. Director confirmed that C1 and C2 have been attending the facility without proof of immunization due to their delayed schedules; see LIC 9099D for deficiency.

On 11/07/2025, LPA conducted parent interviews. One (1) of the six (6) parents interviewed expressed concerns about the allegation that the facility is providing care for children that do not have immunizations prior to admission.

The Orange County Regional Child Care Licensing Office has investigated the complaint alleging that the facility is providing care for children that do not have immunizations prior to admission. Based on information gathered from LPA’s interviews and record review, the preponderance of evidence standard has been met, therefore the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 & Chapter 1, Section 101220.1(a) Immunizations is being cited.

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 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.

End of report.
SUPERVISORS NAME: Tina Nguyen
LICENSING EVALUATOR NAME: Kathy Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 06-CC-20251013105602
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: 12/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2025
Section Cited
CCR
101220.1(a)
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101220.1(a) Immunizations: Prior to admission to a child care center, children shall be immunized against diseases as required by the California Code of Regulations...
This requirement was not met as evidenced by:
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Director stated that they will ask the parents for the proof of immunizations and submit it to LPA by due date. If not, the Director will have parents request for immunization exceptions and submit proof to LPA by due date.
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Based on interview and record review, the licensee did not comply with the section cited above in that, C1 and C2 did not have their immunization records in file, which poses a potential health, safety or personal rights risk to 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.
SUPERVISORS NAME: Tina Nguyen
LICENSING EVALUATOR NAME: Kathy Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
10/13/2025 and conducted by Evaluator Kathy Trinh
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20251013105602

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: 35DATE:
12/09/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director, Jordan WolfTIME COMPLETED:
10:35 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility providing care out of ratio
INVESTIGATION FINDINGS:
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On 12/09/2025, Licensing Program Analyst (LPA), K. Trinh, conducted an unannounced visit to the facility to deliver findings for a complaint that was received at the Orange County Regional Child Care Licensing Office. LPA met with Director, Jordan Wolf and explained the reason for the visit. LPA was led on a tour of the facility and observed a total of 35 children and 4 staff. A review of the Facility Personnel 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 its licensed capacity and within compliance of staffing ratios.

On 10/13/2025, the Orange County Regional Child Care Licensing Office received a complaint with the allegation that the facility is providing care out of ratio. Reporting Party (RP) stated that the facility was out of ratio on 06/11/2025, 06/13/2025, and 6/25/2025. RP provided screenshots of text messages between staff on the dates listed. (Continue to page 2)
Unsubstantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Tina Nguyen
LICENSING EVALUATOR NAME: Kathy Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 06-CC-20251013105602
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: 12/09/2025
NARRATIVE
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(Page 2)

On 10/15/2025, LPA made an unannounced visit to the facility and interviewed five (5) staff. All staff interviewed stated that they have not observed, experienced, or heard about the facility operating out of ratio. All staff shared that if they are about to go out of ratio, the floater or director steps in to maintain compliance with licensing regulations. LPA obtained the facility roster, children’s sign in/out sheet, and staff timecard reports for investigative review. LPA reviewed the children’s sign in/out sheets and staff timecards for the month of September. Based on the census, there is no indication that the facility is operating out of ratio. However, the sign-in and sign-out sheets for June were not available for review.

On 11/07/2025, LPA conducted parent interviews. Parents interviewed did not divulge any information pertaining to the allegation or express any concerns regarding care of the children.

The Orange County Regional Child Care Licensing Office has investigated the complaint alleging that the facility is providing care out of ratio: although the allegation may have happened or is valid, there was not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is 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 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.

End of report.
SUPERVISORS NAME: Tina Nguyen
LICENSING EVALUATOR NAME: Kathy Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5