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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600010
Report Date: 09/15/2020
Date Signed: 09/23/2020 02:43:12 PM

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:ABIDING SAVIOR LUTHERAN CHURCH & SCHOOLFACILITY NUMBER:
300600010
ADMINISTRATOR:WOLFINBARGER, MARYFACILITY TYPE:
850
ADDRESS:23262 EL TORO ROADTELEPHONE:
(949) 837-4292
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:75CENSUS: DATE:
09/15/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Wolfinbarger Mary TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Ketki Desai conducted a Virtual Case Management Licensee initiated inspection for adding a new room (E111) to the Preschool license. The capacity for Preschool shall increase to 85 preschoolers.

LPA met with Facility Administrator Ms. Wolfinbarger, Mary via face time who gave a tour of the new preschool classroom located in Building E room number 111.

The new preschool classroom located in the church building, on the right side of the passage. The room has three exit doors and one bathroom door. The parents shall sign in outside the preschool area in a signing station and the designated teachers shall walk the children to their classrooms.

The new preschool room was observed to have age and size appropriate, furniture, activities, toys and educational items. The bathroom has a one sink and one toilet in the room.

Measurements of the new preschool classroom (E111) is as follows

Preschool room: 24.42 x 19.25 = 470.09 – 14.34 = 455.75



Total space: 455.75 divided by 35= 13.02 children

Sinks and Toilet : 1 sink= 15 children / 1 toilet: 15 children
Page: 1
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ABIDING SAVIOR LUTHERAN CHURCH & SCHOOL
FACILITY NUMBER: 300600010
VISIT DATE: 09/15/2020
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Outdoor yard: There are two play yards designated to preschool children, front yard and back yard: Total Square feet: 6771.85 divided by 75 = 90

Based on today's measurements, facility has enough space for the requested capacity of 85 Preschoolers (2 years –6 years). Monday to Friday 7.00 am to 6.00 PM.

Orange county Fire Authority has granted the Fire clearance for the requested capacity of 85 children,

Administrator Ms. Wolfinbrager Mary has also completed the new Health and Safety Lead poisoning component training and the facility is in process of obtaining the Water testing certificate.

License shall be granted after the final approval by the management.

Report was read to the Facility Administrator and read receipt shall be in lieu of signature.

Copy of the Report with Appeal rights were emailed
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020
LIC809 (FAS) - (06/04)
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