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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371714
Report Date: 11/06/2025
Date Signed: 11/06/2025 02:36:32 PM

Document Has Been Signed on 11/06/2025 02:36 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:OUR SAVIOR'S LUTHERAN PRESCHOOL AND INFANT CENTERFACILITY NUMBER:
304371714
ADMINISTRATOR/
DIRECTOR:		WOHLFARTH, MICHELLEFACILITY TYPE:
860
ADDRESS:200 AVENIDA SAN PABLOTELEPHONE:
(949) 492-6165
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY: 27TOTAL ENROLLED CHILDREN: 82CENSUS: 59DATE:
11/06/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:57 AM
MET WITH:Michelle Wohlfarth - DirectorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 11/6/2025 at 9:57am, Licensing Program Analyst (LPA), A. Silva conducted an announced prelicesing inspection to increase the facility’s preschool and infant capacity, and add a toddler option component. This is a single license conversion. The existing license numbers (300600175 and 304371273) will be consolidated with the new assigned license number (304371714). Upon arrival, LPA met with Director Michelle Wohlfarth. Applicant is requesting to be licensed for infants ages 0-24 mos. in room 304, toddlers ages 18-36 mos. in Room 305 (previously an infant room), and 146 preschool children ages 2-6 yrs in Room 1, 2, 3, 4, 5, 6, 7, 8, and 301. During the visit, capacity changes were discussed and a corrected fire clearance will be requested.

Review of Criminal record clearances were verified through Guardian. All staff were fingerprinted and cleared. The hours of operation are Monday-Friday 7:30am to 4:00pm.

Room 305 activity space measurements based on an existing report dated 12/17/19 measured 572 square feet, which is sufficient for the requested capacity for the toddler option program. Room 305 is equipped with two potty chairs for the children’s use. A toilet and a hand washing sink are available in close proximity to the indoor and outdoor activity space. A potty training seat will be installed on the toddlers’ toilet (The director ordered the potty training seat during the pre-licensing visit and will send pictures once installed).

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NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Archibaldo Silva
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: OUR SAVIOR'S LUTHERAN PRESCHOOL AND INFANT CENTER
FACILITY NUMBER: 304371714
VISIT DATE: 11/06/2025
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Room 305 is equipped with a changing table and sink that will be used for changing diapers only. The changing table has 3-inch sides, and the sink is within hands reach. The furniture fixtures and supplies are age appropriate and sufficient for the capacity requested including tables, chairs, cubbies, bookshelves, and other activity supplies for the children. Drinking water is available in the classrooms via filtered water in pitchers and the children’s own water bottles. LPA observed all hazardous items to be inaccessible to children.

The outside toddler activity space, which is adjacent to rooms 304 and 305, measured 2112 square feet, which is sufficient for the requested toddler capacity. The Toddler Playground is enclosed by the facility walls and a fence. The director states the equipment on the playground is age appropriate.

Rooms 1 and 5 were added to the preschool. Based on previous reports dated 5/11/2018 and 8/6/2020, in addition to the area in 1 and 5, the new square footage for the preschool indoor activity space is 5240.46 square feet, which is sufficient for the requested capacity.

There are 17 sinks, 10 toilets, and 2 urinals available for children’s use. A separate staff bathroom and area adjacent to the Director’s office are designated as isolation area for children who become ill while in care. There are no bodies of water or weapons on the property.

The preschool playground measurement based on a previous visit dated 8/6/2020 is 7230.19 square feet. A playground waiver for outdoor activity space use is already in place. Water is provided via water jug outdoors and children bring their own sports bottles.

Room 304 will be used for infants. Based on an existing report dated 12/17/19, room 304 measures 631 square feet, which is sufficient to accommodate the requested capacity. Based on the same report, the infant outdoor activity space measures 4207 square feet, which is sufficient to accommodate the requested capacity.

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NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Archibaldo Silva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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: OUR SAVIOR'S LUTHERAN PRESCHOOL AND INFANT CENTER
FACILITY NUMBER: 304371714
VISIT DATE: 11/06/2025
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Director 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.

This facility plans to provide 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) 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.

LPA reviewed the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted with Director.

LPA discussed the safe sleep regulations with Director 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 Executive Director 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.

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NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Archibaldo Silva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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: OUR SAVIOR'S LUTHERAN PRESCHOOL AND INFANT CENTER
FACILITY NUMBER: 304371714
VISIT DATE: 11/06/2025
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Director 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.

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 licensed 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 following corrections are needed prior to the issuance of the license:

1. Updated fire clearance request

2. LIC200A to reflect new ages.

3. Potty training toilet seat installation

4. Full review of application packet and corrections requested by LPA

Director understands that all proof of corrections must be provided to the Department within 30 days, or the application may be denied.

A capacity increase for preschool and toddler component addition may be granted after the above requirements are met and a final file review is conducted.

Exit interview conducted and report was reviewed with the Director Michelle Wohlfarth.

End of Report.

NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Archibaldo Silva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC809 (FAS) - (06/04)
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