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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371522
Report Date: 09/21/2022
Date Signed: 09/21/2022 01:06:26 PM

Document Has Been Signed on 09/21/2022 01:06 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:CROSSLINE CHRISTIAN PRESCHOOLFACILITY NUMBER:
304371522
ADMINISTRATOR:STARK, MICHELEFACILITY TYPE:
850
ADDRESS:23331 MOULTON PKWYTELEPHONE:
(714) 646-4285
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: 84TOTAL ENROLLED CHILDREN: 84CENSUS: 40DATE:
09/21/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Adminsitrator Ms. Stark, Michele TIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Desai, Ketki conducted an unannounced Case Management -Licensee Initiated inspection on site. LPA met with Facility Administrator Ms. Stark, Michele on site and toured the facility.
Facility has requested to add a new Infant yard space to the their Infant program. This yard space was used by Preschool children , therefore the Preschool yard space has decreased as follows

Total Outdoor space: 6644'29 divided by 75 = 88'59 (89 children)

Facility has sufficient space to accommodate 84 Preschool children in the current preschool yards,
No changes made to the capacity.

Exit interview conducted with the director Ms. Stark, Michele .

Appeal Rights and Notice of Site visit posted.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2022
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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