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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370877
Report Date: 08/07/2019
Date Signed: 08/07/2019 10:00:11 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:CALVARY BAPTIST CHURCH-IKIDS PRESCHOOLFACILITY NUMBER:
304370877
ADMINISTRATOR:RENEE DURANFACILITY TYPE:
830
ADDRESS:612 NORTH ROSE DRIVETELEPHONE:
(714) 961-5437
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:24CENSUS: 0DATE:
08/07/2019
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator Cynthia Gough and Director Rene Duran.
TIME COMPLETED:
10:15 AM
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An Informal Meeting was conducted on this day in the Orange Regional Office. Present during the meeting were Licensing Program Manager (LPM) Judy Hanson, Licensing Program Analyst (LPA) Andrea Taylor, and Administrator Cynthia Gough and Director Rene Duran.

The purpose of this informal meeting is to discuss the licensee's most recent inspections and the history of the facility.

*10/26/17 - 101429(a)1 - Responsibility for Providing Care and Supervision for Infants-
In addition to Section 101229, the following shall apply:
Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended. An infant was in the nap area
without a staff member.

*8/24/16 - 101416.5 - Staff-Infant Ratio-There shall be a ratio of one teacher for every four infants in attendance.
LPA Taylor observed one staff member inside the crib area with 2 infants and one staff member sitting at the feeding table with 6 infants, 3 of the 6 infants were in the chairs and 3 were on the floor in the activity area.

Licensee put in fencing in the room and added extra staff member to the infant room.

REPORT CONTINUES ON THE NEXT PAGE - 1 OF 2
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
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: CALVARY BAPTIST CHURCH-IKIDS PRESCHOOL
FACILITY NUMBER: 304370877
VISIT DATE: 08/07/2019
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The following was also discussed with the Licensee:
I. The licensee's will be placed on required visits for the next year. The Department will make more frequent
visits for the next year.
II. The licensee was advised that it is her responsibility to know & understand Title 22 Regulations.
III.The licensee's facility must be in compliance at all times.
IV.The licensee was advised to check the Child Care Licensing web site at www.ccld.ca.gov for quarterly updates, training, forms and regulations.

Copies of E-Learning Video list, Lead Poisoning flyer and Safe sleep information was given to Licensee.


Exit interview conducted with Administrator, Cynthia Gough who is in agreement with this report which documents this meeting.

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2