304371523-9-21-2022-06-CC-KDEI-CJGRH5-20220921130147

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371523
Report Date: 09/21/2022
Date Signed: 09/21/2022 01:02:06 PM

Document Has Been Signed on 09/21/2022 01:02 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 PRESCHOOL		FACILITY NUMBER:	304371523
ADMINISTRATOR:	STARK, MICHELE		FACILITY TYPE:	830
ADDRESS:	23331 MOULTON PKWY.		TELEPHONE:	(714) 646-4265
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 28	CENSUS: 12	DATE:	09/21/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Administrator Ms. Stark, Michele		TIME COMPLETED:	12:15 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 Analyst (LPA) Desai, Ketki conducted an unannounced Case Management Licensee initiated inspection at the above facility for the purpose of increasing the Infant capacity by adding room # 108 . LPA observed 8 infants in the assigned Infant room # 1, along with 4 Toddlers in Room # 3 with one staff member, while Room # 2, didn't have any younger infants. Currently facility is licensed for 16 Infants ( 6 weeks to 24 months) in two assigned room # 1 & 2 along with 12 Toddler option children (18 months to 36 months ) in Room # 3. Now facility is requesting to add an additional Room # 4 to the Infant program, along with an infant yard space to accommodate the increase in Infant capacity to 28 infants in Room # 1, 2 and 4 along with 12 Toddler option children. Total capacity now shall be 40 . Infants and Toddlers share the yards on a rotating schedule and there is a Waiver in place. New Infant yard shall be used by the Older infants in new Room # 4 only. Facility shall now use Room # 1,2 and 4 for the Infant program, while Toddler option shall continue to use Room # 3. Facility Director Ms. Stark, Michele gave a tour of the facility including new Infant classroom The following was observed in the new Infant room # 4 (Older Infants 1 year and above) · Age appropriate furniture and equipment’s · Toys, tactile equipment's, carpet area along with wooden flooring · Room is well lighted with ventilation. Cubbies for storage · Infants shall nap on cots and linens and blankets are brought from home · All Infants needed items are brought from home. There is sufficient open area for the child to move (1)

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 PRESCHOOL	FACILITY NUMBER: 304371523
	VISIT DATE: 09/21/2022

NARRATIVE

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Changing table is on wheels with a sink besides it. There are two refrigerators in the room for additional storage of food and milk.

On today’s inspection three infant rooms and Toddler room were measured

Indoor activity space: 1545'56 divided by 35 = 44'16 ( 44 Children) Facility has sufficient space to accommodate the requested capacity of 40 Children ( 28 Infants and 12 Toddlers)

Total sinks: 4 X 15 = 60 children / Total toilets: 1 X 15= 15(children) : Each classroom has a sink inside and there are additional sinks in the facility. Toddlers have a designated toilet in the communal toilet area and additional potty chairs are used by the Toddler children

Facility has sufficient sinks and toilets to support the requested capacity of 40 infants

Outdoor space: Facility now has three infant yards, Infants and Toddlers share the yard on a rotating basis and the new yard added on today's inspection shall be used by Older infants in Room # 4. Facility has an approved Waiver to share the yard on a rotating schedule.
New yard added has a fencing separating the yards and initially this yard was used by Preschool children.
Infant yards have a surrounding fence with soft grass flooring, age appropriate toy and structures are placed on the grass cushion, to absorb any falls and there is sufficient shade provided by a building structure , a shaded canopy and natural trees. Yard is accessed from the lobby area. Facility also uses a buggy to transport the younger infants

Outdoor activity space, Total of three infant yards: 2123'83 divided by 75 = 28'32 ( 28 children)

The new yard added today : 941.64 divided by 75 = 12' 56 ( 13 children)

Facility has a Waiver for the former two yards used by the Infants and Toddlers.

After a tour of the center, no deficiency was observed.

Facility Administrator is current on the required Pediatric CPR/First Training: Valid up to 09/29/2023 (2)

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 PRESCHOOL	FACILITY NUMBER: 304371523
	VISIT DATE: 09/21/2022

NARRATIVE

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LPA discussed the Safe sleep practice with the Director on site Ms. Stark, Michele

NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Fire clearance has been granted by Orange County Fire Authority for the requested capacity of 124 children, Preschool 84 and 40 Infants with Toddler option

LPA discussed the following with the Facility Director Ms. Stark, Michele during the Exit Interview

Criminal Record Statement : Facility Representative (Ms. Ms. Stark, Michele ) was was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

(3)

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 PRESCHOOL	FACILITY NUMBER: 304371523
	VISIT DATE: 09/21/2022

NARRATIVE

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Safe Sleep : LPA discussed the safe sleep regulations with Facility Representative (Ms. Stark, Michele) discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services : This facility provides Incidental Medical services. IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Review of records to be maintained : LPA reviewed with Facility Representative (Ms. Stark, Michele), the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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Based on today’s room measurements/ Outdoor space with sinks and toilets: Facility has sufficient space to accommodate 28 Infants (6 weeks to 24 months) in Room # 1, 2 and 4. Along with 12 Toddler option children in Room # 3. Operating hours: 7.00 AM to 6.00 PM. Total capacity; 124 children.

Notice of Site Visit : A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Appeal Rights presented to the Director.

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

LIC809 (FAS) - (06/04)

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