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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270591
Report Date: 03/15/2021
Date Signed: 03/18/2021 03:14:22 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:ALDERSGATE UNITED METHODIST CHURCH DAY CARE CENTERFACILITY NUMBER:
304270591
ADMINISTRATOR:CAZARES, CHEYENNEFACILITY TYPE:
840
ADDRESS:1201 IRVINE BLVD.TELEPHONE:
(714) 544-5510
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:45CENSUS: 18DATE:
03/15/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Administrator Ms. Cazares, CheyenneTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Ketki Desai conducted an unannounced Case Management Licensee initiated inspection for adding two new classrooms to the school age program.

LPA met with Facility Administrator Ms. Cazares, Cheyenne, who gave a tour of the School age classrooms, play- yards and the new toilets and sinks.

Currently facility is licensed for 45 school age children serving children ages (4.9 to 14 years of age Monday to Friday from 7.00 am- 6.00 PM in the three classrooms (Room # 1,2 and 5).

Facility is now seeking to increase capacity for School age children to 65, by adding two new additional classrooms, 2 play yards with addition of four sinks and five stalls and one urinal for the requested change in capacity.

The two new classrooms are located opposite the Sanctuary area in the back. The two rooms were observed to have age and size appropriate furniture, activities and educational items. Outdoor play yards in front of the Sanctuary area is completely fenced, it has partial grassy area and cemented area and has enough shade. There are designated restrooms for each gender with age appropriate sinks and toilets in front of the play yards.

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

DATE: 03/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021
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: ALDERSGATE UNITED METHODIST CHURCH DAY CARE CENTER
FACILITY NUMBER: 304270591
VISIT DATE: 03/15/2021
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On today’s inspection all the five rooms and play yards were measured.
room #1
29.92
17.5
523.60
20.63
502.97
room #2
29.5
17.42
513.89
14.00
499.89
room # 5
29.42
23.08
679.01
15.50
663.51
Junior High (New added)
24.92
23.25
579.39
15.96
563.43
Senior High (new added)
31.17
23.08
719.40
0.00
719.40
Total indoor capacity: 2949’21 divided by 35 = 84’26 (84 children)

Outdoor activity area: School age shall have accessibility to three designated play yards: School age yard in front of the Classroom # 5, Cemented area in front of the Sanctuary and the Grassy area besides the Cemented area.

Outdoor measurements for all the three yards are as follows:

Cemented yard(new)
38
34
1292.00
1292.00
grass yard (new)
45.17
36.75
1660.00
1660.00
Play yard school age
71.25
44
3135.00
3135.00
Total outdoor activity space: 6087 divided by 75 = 81’16 (81 children)

Total sinks: 10 x15= 150 and Total toilets / Urinals: 9= 135.

Based on today's inspection facility has enough space for the requested capacity of 65 School age children (4.9 years – 14 years). Monday to Friday 7.00 am to 6.00 PM in the designated five classrooms.



Administrator Ms. Cazares, Cheyenne, has completed the On-line CPR class due to current Pandemic situation and is in process of enrolling in-person class also.

Orange county Fire Authority has approved the above requested capacity on 1/27/21.

License shall be granted after the final approval by the management. Report was read to the Facility Administrator and appeal rights were provided. Notice of site visit posted.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021
LIC809 (FAS) - (06/04)
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