300600220-3-13-2025-06-CC-MMAK-DEQQQ8-20250313122155

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300600220
Report Date: 03/13/2025
Date Signed: 03/13/2025 12:22:16 PM

Document Has Been Signed on 03/13/2025 12:22 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:	LAGUNA PRESBYTERIAN PRESCHOOL		FACILITY NUMBER:	300600220
ADMINISTRATOR/ DIRECTOR:	HERZOG, ANNE		FACILITY TYPE:	850
ADDRESS:	415 FOREST AVENUE		TELEPHONE:	(949) 494-0504
CITY:	LAGUNA BEACH	STATE: CA	ZIP CODE:	92651
CAPACITY: 105	TOTAL ENROLLED CHILDREN: 105	CENSUS: 7	DATE:	03/13/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Director		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Page 1 of 4 Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek conducted an onsite inspection for the purpose of an Annual inspection. LPA met with Director, Anne Herzog. There was a total of 7 children with a total of 9 staff in 5 different classrooms. The teacher child ratio was one staff with no children in Room # 5, two staff with 2 children in Room 7, three staff with 3 children in Room # 3, one staff with 3 children in Room # 2, and one staff with one child in Room # 1. The rest of the rooms were not currently in use (Room # 4 downstairs and Rooms 8, 9 ,201, and 202 in upstairs). Parents drop off their children starting at 9:00 am and they sign in and out electronically. 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. LPA toured of the facility inside and outside. The floor and yard plan (LIC 999) were checked. Facility hours are 7:30 a.m - 5:30 p.m., Monday through Friday. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Children nap on floor mats. Parents provide beddings for children. LPA observed they were stored separately. The beddings are sent home to be washed on a weekly basis. All the classrooms were inspected. During the inspection of the indoor activity space, items which could pose a danger to children (cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Parents provide morning, afternoon snacks and lunch to children. Continue to page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LAGUNA PRESBYTERIAN PRESCHOOL	FACILITY NUMBER: 300600220
	VISIT DATE: 03/13/2025

NARRATIVE

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Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. Drinking water is available to children indoors by water containers children bring from home and the facility fill them up at the facility if needed.

The facility has conducted an emergency drill within the past six months, last drill was in 10/17/2024.
The facility has Carbon Monoxide Detective which is operable. Facility met all posting requirement.

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. There was enough cushioning around and under the play structure/slide to absorb fall. (sand)
Drinking water in the outdoor activity space is provided by water containers which facility fill them up at the facility if needed. The outdoor equipment and toys were in good repair and free of sharp edges. Shade is provided. There are no bodies of water present at the facility.

Staff files were reviewed for staff present during the facility inspection on this date, 9 staff files were reviewed. Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a childcare center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff were reviewed and were not in compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. They were not in compliance. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications. They were in compliance.

Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of 5 children's files were reviewed for documentation of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached when necessary (LIC 700) and
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LAGUNA PRESBYTERIAN PRESCHOOL	FACILITY NUMBER: 300600220
	VISIT DATE: 03/13/2025

NARRATIVE

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a medical assessment. In the areas reviewed the children’s files were found to be in full compliance. Children's files were all in compliance.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs)
constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP on 4/6/2023.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 are available at:https://www.ada.gov/resources/child-carecenters

The facility representative, Anne Herzog 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.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LAGUNA PRESBYTERIAN PRESCHOOL	FACILITY NUMBER: 300600220
	VISIT DATE: 03/13/2025

NARRATIVE

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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 communications.

The director, Anne Herzog 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.

To improve the quality and value of the new inspection process, a survey may be sent to the

email address provided. Please complete the survey and share your inspection experience. If
you have any questions regarding the process or CARE tools, please send email inquiries to
inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its
tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given to facility representative, Shannon Valdez and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

In the areas that were evaluated, the following deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at this inspection date. Please refer to LIC 809D attached to this report for details of deficiencies.

Exit interview was conducted with director, Anne Herzog.

End of report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

Page: 4 of 6

Document Has Been Signed on 03/13/2025 12:22 PM - It Cannot Be Edited

Created By: Mahnaz Malek On 03/13/2025 at 11:39 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LAGUNA PRESBYTERIAN PRESCHOOL	FACILITY NUMBER: 300600220
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, and record review, the licensee did not comply with the section cited above in 3 files out of 9 files that S3, S8, and S9 were missing the certificates which poses a potential health, and safety risk to persons in care.
	POC Due Date: 03/24/2025
	Plan of Correction
1 2 3 4	The licensee agreed to sent the certificates of Mandated Reporter Training for S3, S8, and S9 to LPA's email by the due date of 3/24/2025.

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, and record review, the licensee did not comply with the section cited above in 3 files out of 9 files that S2, S6, and S9 were missing the required immunizations of MMR and Pertussis vaccine which poses a potential health, and safety risk to persons in care.
	POC Due Date: 03/24/2025
	Plan of Correction
1 2 3 4	The licensee agreed to send the required immunizations for S2, S6, and S9 to LPA's email by the due date of 3/24/2025.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Thuy Ho

LICENSING EVALUATOR NAME:

Mahnaz Malek

LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

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