300604497-10-15-2021-06-CC-KDEI-C7TRS6-20211015131613

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300604497
Report Date: 10/15/2021
Date Signed: 10/15/2021 01:16:24 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:	CHRIST LUTHERAN PRESCHOOL		FACILITY NUMBER:	300604497
ADMINISTRATOR:	LISA HOLLOWAY		FACILITY TYPE:	850
ADDRESS:	760 VICTORIA STREET		TELEPHONE:	(949) 631-1639
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92627
CAPACITY:	122	CENSUS: 78	DATE:	10/15/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Lead Teacher Ms. Reike, Michelle		TIME COMPLETED:	01:30 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

Licensing Program Analyst (LPA) Ketki Desai conducted an unannounced Case Management (other) inspection for a follow up to re-measure all the three yards in the facility. LPA met with Lead Teacher Ms. Rieke, Michelle who gave a tour of the facility.

Currently facility is licensed for 122 Preschool age children, including 12 Toddlers and is now seeking to increase capacity to 134 children ages from 2 to 6 years of age, Monday through Friday, 6.30 AM to 6.30 PM in the previously assigned rooms (Room # 107,109,110,111,116 for Preschool and Room # 115 for Toddler component and now is adding Room #108 to the preschool License.

On today’s inspection, all the three yards were measured

AREA IDENTIFICATION	LENGTH	WIDTH	AREA	ENCUMBERED	SPACE
Preschool/Toddler yard	67.5	55.5	3746.25		3746.25
Big Yard	133	52	6916.00		6916.00
new yard in front of Rm 107	46.67	45	2100.15		2100.15

Total outdoor space = 12762’40 Sq Ft divided by 75= 170’17 (170 children)

The facility has sufficient outdoor space for 134 preschool age children, the three yards shall be used on a rotating schedule between the seven licensed classrooms.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

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: CHRIST LUTHERAN PRESCHOOL	FACILITY NUMBER: 300604497
	VISIT DATE: 10/15/2021

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
26
27
28
29
30
31
32

Each yard was observed to have proper fencing and shade with concrete flooring and age appropriate outdoor activities items were observed.

Facility will request a Waiver for rotating schedule between the 7 classrooms.

Fire clearance from City of Costa Mesa Fire prevention office has been received on 9/24/21 and approved for 134 preschool age children, total including 12 Toddlers.

Based on today’s indoor measurements, total sinks/toilets and outdoor space, Facility has sufficient space to accommodate the requested capacity of 122 Preschool children and 12 Toddlers: Total capacity 134 children in room # 107,108, 109,110,111 and 116 for Preschool children and Room # 115 for Toddler component

Facility Director shall be notified if additional information is needed.

A copy of this report, Appeal rights were presented to the Facility Lead Teacher Ms. Reike, Michelle.

Exit interview conducted. Notice of Site Visit was posted. Director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post it will result in civil penalties of $100.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2