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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371648
Report Date: 11/05/2024
Date Signed: 11/05/2024 02:59:26 PM

Document Has Been Signed on 11/05/2024 02:59 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CHRIST LUTHERAN PRESCHOOL HUNTINGTON BEACHFACILITY NUMBER:
304371648
ADMINISTRATOR/
DIRECTOR:
ROBLES, DESIREEFACILITY TYPE:
860
ADDRESS:8200 ELLIS AVENUETELEPHONE:
(714) 962-5571
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 53TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
11/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Desiree RoblesTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Dean Thompson conducted an unannounced case management incident inspection in response to a self reported Unusual Incident dated 10/31/2024. LPA met with Director Desiree Robles and toured the facility. LPA observed 4 preschool children with one preschool staff and 2 toddler age children with 1 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 the visit, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

On 10/31/2024, a self reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported a parent stating that their child claimed a teacher placed them inside a trash can on 10/29/2024.

On 11/5/2024, LPA interviewed three staff. Staff interviewed did not divulge any information pertaining to the allege incident. On 11/5/2024, LPA attempted to interview three preschool age children present. Children were not qualified to be interviewed.

Based on interviews, LPA did not observe any violation of Title 22 Regulations.

Exit interview conducted and report was reviewed with Director Desiree Robles. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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