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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370364
Report Date: 06/11/2019
Date Signed: 06/11/2019 08:55:07 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:GRACE LUTHERAN P.S. SITE #2FACILITY NUMBER:
304370364
ADMINISTRATOR:WHEELER, LISAFACILITY TYPE:
850
ADDRESS:5172 MCFADDEN AVENUETELEPHONE:
(714) 899-1600
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92649
CAPACITY:114CENSUS: 38DATE:
06/11/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Lisa Wheeler, DirectorTIME COMPLETED:
09:20 AM
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An inspection was conducted at the facility by Licensing Program Analyst (LPA) Port. This is a follow-up inspection in response to the Type A deficiency cited on 05/31/2019. During the inspection on 05/31/2019 it was determined the facility was not operating within compliance of staffing ratios. Proof of correction was received on 06/03/2019.

A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

Upon arrival, LPA met with Lisa Wheeler and census was taken. LPA observed 26 preschool age children and 3 staff members on the large outdoor yard and 12 preschool age children and 2 staff members on the small outdoor yard. During today's inspection it was determined that the facility was operating within its licensed capacity and within compliance of staffing ratios.

There was no deficiency cited during today's inspection.

Exit interview was conducted with Director, Lisa Wheeler. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Facility representative was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy PortTELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
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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