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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371648
Report Date: 11/13/2023
Date Signed: 11/15/2023 04:12:48 PM

Document Has Been Signed on 11/15/2023 04:12 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:CHRIST LUTHERAN PRESCHOOL HUNTINGTON BEACHFACILITY NUMBER:
304371648
ADMINISTRATOR:ROBLES, DESIREEFACILITY TYPE:
850
ADDRESS:8200 ELLIS AVENUETELEPHONE:
(714) 962-5571
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 53TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/13/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:17 AM
MET WITH:Desiree Robles, Director, & Emily Martinez, Exec. DirectorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst, (LPA )P Rivas met with Designated Applicant/ Director Desiree Robles and
Emily Martinez, Executive Director, and conducted an announced pre licensing inspection.

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.
The applicant has requested to provide care and supervision to 10 toddlers ages 18 months to 36 months old from Toddler Option Component in Toddler room and 43 preschool children in Rooms C1, C2, C3 and C4.
There will be a total of 35 children enrolled in a half day program from Monday to Friday from 8:00am to 12:00pm and 18 children in a full day program from 7:30am to 5:00pm.

Parents sign in and out manually in front of each classroom. Isolation area is the director's office in the lobby area with an additional cot and bedding. The one outside child's bathroom will be used if needed for the sick child until child is picked up.

LPAs discussed the posting requirements including, but limited to, the following:
· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610)
· Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393)
· Menus / Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies / Plan of Corrections of Type A deficiencies
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CHRIST LUTHERAN PRESCHOOL HUNTINGTON BEACH
FACILITY NUMBER: 304371648
VISIT DATE: 11/13/2023
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· Granted Waivers (available for review)
· Child Car Seat Law (PUB 269) & COVID Posters.
The following was observed in the classrooms:
Age appropriate furniture and equipment’s, Toys, tactile equipment's. Rooms are well lighted with ventilation. There is sufficient open area for the child to move. Storage cubbies are arranged to store personal belongings. Flooring consists of carpet and linoleum. All food will be supplied by parents, but facility will have emergency supply on hand.
LPA viewed a bathroom in Toddler room with a toilet and sink and changing table. LPA discussed the positioning of the changing table for visual observation of children while using it and being within the arm's reach of a sink. The diaper changing table has padded surface no less than one inch thick with washable vinyl. It has raised sides on three sides at least 3 inches high. (measured)
Children sleep on and cots. Beddings are provided by the parents and are washed weekly . The facility will have extra bedding available. The facility will have sufficient cots for the total full time capacity
LPAs measured the assigned rooms for preschool and toddler option:
The toddler option room measured at 346.51 square feet. Rooms C1, C2, C3, C4 measured at 1575.63 which is sufficient indoor capacity for the requested capacity.
There were a a total of 5 sinks and 7 (toilets/urinals) which is sufficient for the requested capacity.
There is an exit gate leading to outdoor storage area which is locked with padlock A knox box will be put in place for fire Dept. . Shade is provided by l awnings and building structure and a tree.
Fire clearance received from Orange County Fire Authority approving the requested capacity of 53 children was received.

The director, Desiree Robles is current on the required Immunization/Mandated Child abuse reporting training course taken 08/04/2023 Her EMSA Pediatric CPR/First training certificate expires 08/10/25. She also has EMSA approved Preventive Health and Safety training with lead poisoning and nutrition training Course taken 08/25/2023.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CHRIST LUTHERAN PRESCHOOL HUNTINGTON BEACH
FACILITY NUMBER: 304371648
VISIT DATE: 11/13/2023
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The facility representative, Desiree Robles 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

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) or (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. The plan has been submitted to LPA.
LPAs discussed the safe sleep regulations with director, Lura Nixon and 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 the director, Desiree Robles 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.
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important license related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. The facility representative was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CHRIST LUTHERAN PRESCHOOL HUNTINGTON BEACH
FACILITY NUMBER: 304371648
VISIT DATE: 11/13/2023
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LPA reviewed with applicant the following safe sleep best practices:
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 if they do not have items attached to them
· Infant LIC 9227 and infant sleep log for every 15 minutes were discussed.
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 discussed lead testing requirements;
Written Directives for Lead Testing;
For a license issued on or after July 1, 2022 initial testing results shall be received and posted within 180 days of licensure. LPA was advised that the facility was constructed before January 1, 2010.
LPA was also advised that drinking water will be provided via a brita water filter and water will be obtained from outside drinking fountain between two outside bathrooms.

Following items were discussed at the time of Exit interview.

Out Door space was not measured as the fencing for toddler component is not in place and the equipment and supplies are not fully in place.

The following is needed prior to licensure
1. Complete fencing for facility (including fencing to separate the toddler component.)
2. Measurement of outside activity space.
3. Provide picture of required postings
4. Facility sketch lic 999 with off limit areas.
5. Final review and approval from by Management.
Items to be provided by December 13, 2023
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
LIC809 (FAS) - (06/04)
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