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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370252
Report Date: 08/19/2020
Date Signed: 08/19/2020 11:46:03 AM

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:SALVATION ARMY, TUSTIN RANCH-HENLEY YOUTH CTR, THEFACILITY NUMBER:
304370252
ADMINISTRATOR:BANKER, DIANEFACILITY TYPE:
840
ADDRESS:10200 PIONEER ROADTELEPHONE:
(714) 210-6050
CITY:TUSTINSTATE: CAZIP CODE:
92782
CAPACITY:75CENSUS: 26DATE:
08/19/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Administrator Banker DianeTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Ketki Desai conducted a in person Case Management Licensee initiated inspection for a change of capacity at the above facility. LPA met with Facility Administrator Ms. Banker Diane, who gave a tour of the new classrooms located in Fellowship Hall: Room # 1, 2, 3 and the Gymnasium area, which is currently used by the School age children. There were 26 children present in the Gymnasium area with Four staff at the time of inspection.

On today's inspection the capacity for School age children is being increased by adding three new classrooms along with the current Gymnasium area, these classrooms shall be used by School age children (4.5 years to 14 years of age) Monday to Friday from 7.00 am to 6.00 pm. The three new rooms shall be mainly used by middle school children for homework purposes. School age children have designated toilets and sinks for boys and girls.



Measurements of the three new rooms and Gymnasium area is as follows
Room # 1= 18.25 x 17.58= 320.84
Room # 2= 17.58 x 17.10= 313.45
Room # 3= 18.08 x 13,83= 250.05
Gymnasium = 93.5 x 75.5= 7059.25

Total space: 7943.58 divided by 35= 226 children
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020
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: SALVATION ARMY, TUSTIN RANCH-HENLEY YOUTH CTR, THE
FACILITY NUMBER: 304370252
VISIT DATE: 08/19/2020
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Sinks and Toilet behind the reception area (Designated toilets for Boys and Girls)
9 sink= 130 children
8 stalls & 3 urinals (9 toilets) 130 children

The outdoor area was measured, and the findings are as follows:
North courtyard area: 10,800 sqft
South grassy area: 8,000 sqft
South courtyard: 2,035 sqft
Total 20,835 sqft divided by 75 = 278 children

Currently the facility is licensed for 75 School age children and is seeking to increase the capacity by adding additional 50 school age children with a Total capacity of 125 School age children

Based on today's measurements, facility has enough space for the requested capacity of 125 School age children serving ages 4.5 years old to 14 years. Monday to Friday 7.00 am to 6.00 PM.

Orange county Fire Authority has granted the Fire clearance for the requested capacity of 125 School age children.

Administrator Ms. Banker Diane has also completed the new Health and Safety Lead poisoning component training along with the water testing for the facility.

This report and the appeal rights were presented to the Director Ms. Diane Banker
Exit interview conducted and Notice of Site visit issued
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020
LIC809 (FAS) - (06/04)
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