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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370218
Report Date: 12/07/2021
Date Signed: 12/07/2021 10:07:36 AM

Document Has Been Signed on 12/07/2021 10:07 AM - 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:SURF CITY CHRISTIAN CHILD DEVELOPMENT PRESCHOOLFACILITY NUMBER:
304370218
ADMINISTRATOR:HOPKINS, TAMARA ANNFACILITY TYPE:
850
ADDRESS:5432 & 5452 HEIL AVENUETELEPHONE:
(714) 846-0316
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92649
CAPACITY: 140TOTAL ENROLLED CHILDREN: 140CENSUS: 88DATE:
12/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Tamara Hopkins, DirectorTIME COMPLETED:
10:30 AM
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An unannounced case management visit was conducted on this date by LPA Nguyen. The purpose for today’s visit was to follow up with the waiver request to serve 12 school-age children using classroom #8. Preschool children will not be using the room #8 while school age children present. Facility is currently licensed for 140 preschool children.

LPA’s met with director Tamara Hopkins and toured the facility. Census was taken as follow: 88 preschool children with 10 staff members including the director. A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today’s inspection, LPA Nguyen observed the school-age classroom is set up and has adequate inside space for 12 children only. There is a restroom and play yard area that uses for school-age children and will not share with preschool children. Director acknowledges that:
  1. The number of extended day school-age children not to exceed 12 children.
  2. Extended day school-age children not to exceed twelve years of age.
  3. A ratio of one teacher to 12 children will be maintained at all times.
  4. School-age children and Preschool children must be kept separated at all times.
  5. School-age children will have access to a toilet that provides individual privacy and will have separate yard or scheduled outdoor playtime.
After a tour of the center, no deficiency was observed. File will be submitted for approval as of today.

Exit interview conducted. Notice of Site Visit was posted. Licensee 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. “The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.”
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2021
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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