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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300602967
Report Date: 02/27/2019
Date Signed: 04/14/2021 02:21:30 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:GRACE CHRISTIAN PRESCHOOLFACILITY NUMBER:
300602967
ADMINISTRATOR:SPIELMAN, JULIEFACILITY TYPE:
850
ADDRESS:26052 TRABUCO ROADTELEPHONE:
(949) 951-8683
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:150CENSUS: 70DATE:
02/27/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Director, Spielman, JulieTIME COMPLETED:
05:20 PM
NARRATIVE
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*This is an amended report* An inspection was conducted at the facility by Licensing Program Analysts (LPAs) Nguyen & Taylor. The facility file was reviewed prior to this inspection. A review of staff records indicates that four, Linda Gonzalez, Debbie Guajardo, Celeste Montes, and Sandrella Salins out of 17 staff had not had criminal record and child abuse clearance associated to this facility. Operating hours are 8:30am- 6:00pm, Monday through Friday.

LPAs observed 70 preschool children and 17 staff members. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

The facility was toured inside and outside and the floor and yard plan were verified. The facility representative stated there is no bodies of water on site. LPAs confirmed with facility representative that firearms/weapons are not allowed or stored on premises. The facility appeared clean and orderly. The items which could pose a danger to children (disinfectants and cleaning solutions) were stored out of the reach of children. The director stated poisons/hazardous items are not stored on site and none were observed during today's inspection. All materials and surfaces accessible to children are toxic free. The children’s bathrooms were observed to be in safe and sanitary operating conditions.

All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Snacks are provided and prepared on site. Food prep areas appear clean and sanitary. Food is properly stored. On site kitchen is free from hazards. Solid waste receptacles have a tight-fitting cover and are in good repair.

Children nap on cots/mats, and bedding is sent home weekly to be laundered by parents. There is drinking water available to children both indoors and outdoors. A current menu is posted is a prominent location viewable by an authorized representative.
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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GRACE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300602967
VISIT DATE: 02/27/2019
NARRATIVE
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The facility representative stated menus are dated, kept on file for 30 days and viewable upon request. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher that meet statutory requirements.

The playground was completely fenced. The playground equipment appeared in safe condition, and play area is free from hazards. There is sufficient artificial grass cushioning underneath climbing structures and/or play equipment to absorb falls.

The facility has conducted an emergency drill within the past six months. A random sample of ten children's files were reviewed and found to be in substantial compliance.

Staff files for staff present during today’s inspection were reviewed for appropriate documentation. At least two staff members present possesses current CPR/First Aid certifications, which expires 08/2019. Not all the staff have the immunization's against influenza (or written decline), pertussis and measles for employees during today's inspection. Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years, per A.B. 1207. Not all the staff have the completion as required by AB 1207 was observed in staff files.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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)/ (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.

Facility representative was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GRACE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300602967
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
02/27/2019
Section Cited

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not met as evidenced by:
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Based on record reviews, it was determined that four, Linda Gonzalez, Debbie Guajardo, Celeste Montes, and Sandrella Salins out of 17 staff had not had criminal record and child abuse clearance associated to this facility. This poses an immediate health and safety risk to children in care.
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A civil penalty of $2000 was assessed.

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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2021
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GRACE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300602967
VISIT DATE: 02/27/2019
NARRATIVE
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Documents/Information to be updated and returned to the Licensing Office:
- Application (LIC 200A)
- Personnel Report (LIC 500)
- Emergency Disaster Plan (LIC 610)
- Designation of Administrative Responsibility (LIC 308)
- Children's Roster

Based on LPAs observations and record reviews the following violations were observed is being cited in accordance with California Code of Regulations, Health and Safety code 1597.7995(a)(1) and 1596.8662 (b)(1), and, Title 22, Division 12, Section 101170(e)(2) is being cited on the attached LIC 809D. A civil penalty of $2000 has been assessed.

Exit interview was conducted with director, Julie Spielman. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Facility representative was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov

If the facility receives a Type A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days, and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.


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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: GRACE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300602967
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2019
Section Cited

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101221 Child's Records (b)Each record shall contain information including, but not limited to, the following: (8)Medical assessment, including ambulatory status as specified in Section 101220, and the following health information: This requirement is not met as evidenced by:
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Based on record reviews, the facility representative failed to ensure to maintain children's medical assessment record. This poses a potential Health and Safety risk to the children in care.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: GRACE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300602967
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2019
Section Cited

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1597.7995(a)(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...
This requirement is not met as evidenced by:
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Based on interview and record reviews, the facility representative failed to ensure to maintain staff immunization record. This poses a potential Health and Safety risk to the children in care.
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Type B
03/20/2019
Section Cited

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1596.8662.(b)(1)… mandated reporter…proof of completion(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care providing the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
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Based on interview and record reviews, the licensee failed to ensure to have mandated reporter training certificates. This poses a potential Health and Safety risk to the children in care.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2021
LIC809 (FAS) - (06/04)
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