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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606156
Report Date: 10/27/2021
Date Signed: 10/27/2021 01:13:24 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:TRINITY LUTHERAN CHURCH & CHRISTIAN SCHOOLFACILITY NUMBER:
300606156
ADMINISTRATOR:GINESI, STACEYFACILITY TYPE:
850
ADDRESS:4101 EAST NOHL RANCH ROADTELEPHONE:
(714) 637-8370
CITY:ANAHEIMSTATE: CAZIP CODE:
92807
CAPACITY:120CENSUS: 68DATE:
10/27/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Ms. Ginesi,Stacey TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Desai, Ketki conducted an unannounced Case Management Licensee initiated inspection at the above facility for the purpose of adding new classrooms, play yards, bathrooms along with the change in ages to be served.

Currently facility is licensed for 120 preschool age children, 2-5 years old in Room # C 1,3,4,5, 6, 7, 9 & the Faith room. There were 68 preschool age children with 11 staff members.

Facility Administrator Ms. Ginesi, Stacey gave a tour of the facility including new classrooms, new play yards and the bathrooms to be added.

The Private Elementary school on the premises is no longer in operation since March 2019. Only Church offices, The Church and Preschool are using the premises.

Application has been received to modify the ages to be served, now facility shall serve Preschool age children from 2-6 years old. Operating hours for this program will be Monday to Friday 7:00 AM to 6:00 PM (full day session) and half day session from 8:00 AM to 12:00 PM

The following was observed in new rooms # 103/ 104 /105 and 106 and the formerly licensed rooms
· Age appropriate furniture and equipment’s
· Educations items (Learning and Science activities)
· Arts and Crafts activities.
· Rooms are well lighted with ventilation.
· Drinking water is available through filtered water bottle station / Water pitchers and personal water bottles
· AM/PM snack is offered, and Lunch is brought from home, but children do bring in their own snacks.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
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: TRINITY LUTHERAN CHURCH & CHRISTIAN SCHOOL
FACILITY NUMBER: 300606156
VISIT DATE: 10/27/2021
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· Electronic sign in and out (Bright wheel application)
· CDC Guidelines are being followed.
· Each of classroom has a sink inside
· Children shall nap on cot / mats and lines are brought from home.

On today’s inspection facility, is adding additional new four rooms along with the formerly licensed 8 rooms in 2018 with a capacity of 120 preschool age children.

LPA re-measured the rooms being used and it was confirmed there is no Classroom # 9 on premises. Missing was C-2 which was measured, and the measurements are as follows:

Faith Classroom: 24 x 19.416 = 466
Classroom C1: 27.75 x 24.75 = 687
Classroom C2: 25.66 x 23.33 = 575
Classroom C3: 24.66 x 23.33 = 575
Classroom C4: 24.66 x 23.33 = 575
Classroom C5: 24.66 x 23.33 = 575
Classroom C6: 24.66 x 23.33 = 575
Classroom C7: 25 x 18.66 = 466.5

Total indoor activity space: 4495 divided by 35 = 128 children

On today’s inspection following rooms are being added to the License

ROOM IDENTIFICATION LENGTHWIDTH
AREA
ENCUMBERED
SPACE
Room # 103
31.08
19.25
598.29
4.26
594.03
Room # 104
31.08
19.25
598.29
8.87
589.42
Room # 105
31.08
19.25
598.29
4.26
594.03
Room # 106
31.08
20
621.60
0.00
621.60
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: TRINITY LUTHERAN CHURCH & CHRISTIAN SCHOOL
FACILITY NUMBER: 300606156
VISIT DATE: 10/27/2021
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Total Indoor space: 2399’08 + 4495 = 6,894’08 divided by 35= 196’97 (197 children)

Currently facility is not changing their current capacity, it remains at 120 children as approved before.

Total sinks: 17 X 15 = 255 children
Total toilets: 15 X 15= 225 (Children)

Outdoor space: Current play yards: Facility is using two formerly licensed play yards as follows:
Upper play area: 5155 div 75 = 69
Lower Play area: 3269 div 75 = 45
Total outdoor space= 8424 div 75= 112

New play yards added on today’s inspection
AREA IDENTIFICATION LENGTHWIDTH
AREA
ENCUMBERED
SPACE
Play structure & Lunch area
81
72.33
5858.73
5858.73
Courtyard
82.67
57.33
4739.47
4739.47
Indoor activity room: Fellowship hall
67.17
40.75
2737.18
2737.18
Sport court area
122
116
14152.00
14152.00

Total outdoor space for the above four play yards measured on 10/27/21
27,487’38 divided by 75= 366’50
8424 divided by 75= 112 (measured in 2018) ( Total: 112+366 = 478 children)
Facility now has enough outdoor space to accommodate 120 children in the above yards.

All the play yards in the facility has safe metal fencing surrounding it, the yards has sufficient shade provided by awing sails and covered wooden deck/ Play structures are placed on a soft turf cushion to absorb any falls/ All the play structures are appropriate for preschool age children/ Drinking water is available through Water filtered dispenser stations installed and children also carry their personal water bottles / each play yards are accessible from the classrooms.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: TRINITY LUTHERAN CHURCH & CHRISTIAN SCHOOL
FACILITY NUMBER: 300606156
VISIT DATE: 10/27/2021
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After a tour of the center, no deficiency was observed.

The facility representative was informed that the CRIMINAL RECORD STATEMENT (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182).

The facility representative was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov

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


Fire clearance has been granted by Anaheim Fire prevention office for a capacity of 120 Preschool age children in Room # C1/ C2 /C3 /C4 /C5 /C6 /C7/ Faith room / Room # 103/104/105 and106.
Play yards: Upper play yard/Lower Play yard/ Play structure & shaded Lunch area / Courtyard/ Indoor activity area: Fellow ship hall and Sport court area.

Facility Administrator is current on the required Pediatric CPR/First Training: Valid up to 9/2022

Based on today’s room measurements/ Outdoor space with sinks and toilets: Facility has enough Indoor space to support 120 Preschool age children (2-6 years old) in Room # C1/ C2/ C3/ C4/ C5/ C6/ C7/ Faith room / Room # 103/104/105 and 106.
Play yards: Upper play yard/ Lower Play yard / Play structure & shaded Lunch area / Courtyard/ Indoor activity area: Fellow ship hall and Sport court area.

Operating hours: 7:00 am to 6.00 pm. Preschool age 2-6 years old.
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.

Appeal rights presented to the Director. Exit interview conducted.

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4