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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371648
Report Date: 01/04/2024
Date Signed: 01/04/2024 11:31:17 AM

Document Has Been Signed on 01/04/2024 11:31 AM - 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: 53CENSUS: 0DATE:
01/04/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Desiree Robles, applicant/directorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst, (LPA )P Rivas met with Designated Applicant/ Director Desiree Robles and conducted an announced pre licensing inspection to finish the inspection commenced on 11/13/2023.
The applicant had to complete construction on outside activity space, including but not limited to fencing toddler area, removing asphalt and paving with Decomposed Granite(DG). Due to unforeseen construction delays the continuation of the pre licensing visit was completed this date.

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.

On 11/13/2023 LPA Rivas had observed equipment and supplies that were age appropriate for outside play. There are no bodies of water on the premises. There are no swings, climbing equipment or slides.
Ms. Emily Martinez, Executive Director, joined during visit.

Outside shade structures is a permanent canopy which is sufficient for requested capacity. The facility currently has a fully fenced playground area. Fencing side is a brick wall and chain link fence which are at least four feet high. Toddler playground is fenced via a laminate fencing. Drinking water is available via outside drinking fountain or from water filtration pitcher and cups
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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: 01/04/2024
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On 11/13/23 LPA had measured indoor capacity space as follows;
There were a a total of 5 sinks and 7 (toilets/urinals) which is sufficient for the requested capacity.
LPA 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. A total of 5 rooms were measured.
The total outdoor activity space measured at 10473.79 square feet.

The following was received
1. Provided picture of required postings
2. Facility sketch lic 999 with off limit areas. and fenced in area.

The following is needed prior licensure;
1. Final review and approval from by Management.

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.

An exit interview was conducted with Ms. Robles.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC809 (FAS) - (06/04)
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