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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606156
Report Date: 09/14/2022
Date Signed: 09/14/2022 01:52:22 PM


Document Has Been Signed on 09/14/2022 01:52 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
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: 48DATE:
09/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Stacey Ginesi, DirectorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Stacy Torrence conducted an unannounced Case Management visit. LPA met with Stacey Ginesi, Director, to discuss the Lead Sampling Testing conducted on 08/09/2022. Director was advised on 09/06/2022 that the Lead Sample Report was to be posted. LPA confirmed that Director had posted the Lead Sample Report.

Director stated the sink with the high level of Lead is located in Room C1, is not in operation and has never been used for children as a drinking source. During today’s inspection, LPA Torrence observed the sink inoperable with an Out of Service sign taped over it. Source of drinking water is available by the children bringing their own water bottles from home, labeled with their names and in every classroom, there are either individual water bottles or a Sparklett water dispenser available for refills.

Exit interview conducted and report was reviewed with the facility representative Stacey Ginesi. A notice of site visit was given and must remain posted for 30 days.



Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022
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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