304371100-6-17-2021-06-CC-STOE-C43QLS-20210617121625

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371100
Report Date: 06/17/2021
Date Signed: 06/17/2021 12:16:30 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:	DONG SHIN CHRISTIAN PRESCHOOL		FACILITY NUMBER:	304371100
ADMINISTRATOR:	KIM, HAEWON		FACILITY TYPE:	850
ADDRESS:	2505 E. YORBA LINDA BLVD.		TELEPHONE:	(657) 378-9653
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92831
CAPACITY:	120	CENSUS: 87	DATE:	06/17/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Haewon, Kim, Owner		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Stacy Torrence for the purpose of capacity increase. The facility has requested to add classroom #111A to the preschool program license. The facility is currently licensed for 120 children and is requesting to increase to 145 children. LPA Torrence met with Director Haewon Kim, who guided analyst on a tour of the facility. Census was taken. There were 87 preschool children present; with 12 staff supervising. Operations hours are Monday-Friday; 7:30 a.m.-6:00 p.m. Waiver for rotating outdoor activity schedule on file. 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. The director’s office is located down the hallway from the first entrance and will serve as the isolation area for ill children temporarily until parents arrive. The staff bathroom will be used as the isolation bathroom and is located down the hallway from the second entrance. First Aid kit is complete. Sign in / Sign out procedure was reviewed. This facility utilizes an electronic sign in/out system. The facility provides breakfast, lunch, and PM snack. Food prep areas appear clean and sanitary. Food is properly stored. Indoor Activity Space Measurements: Classroom 131: 22 x 18'7" = 408' - 14' encumbered = 394/35' = 11 children. Classroom 105: 17'10 x 29' = 517'- 20' encumbered = 497'/35' = 14 children. Classroom 106: 20' x 22' = 440' - 14' encumbered = 426'/35' = 12 children. Classroom 104: 20' x 22' = 440' - 14' encumbered = 426'/35' = 12 children. Classroom 107: 20' x 22' = 440' - 14' encumbered = 426'/35' = 12 children. Classroom 103: 20' x 22' = 440' - 14' encumbered = 426'/35' = 12 children.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

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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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: DONG SHIN CHRISTIAN PRESCHOOL	FACILITY NUMBER: 304371100
	VISIT DATE: 06/17/2021

NARRATIVE

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Classroom 108: 20' x 22' = 440' - 14' encumbered = 426'/35' = 12 children.
Classroom 102: 20' x 22' = 440' - 14' encumbered = 426'/35' = 12 children.
Classroom 101: 17'7 x 27'2 = 477' - 14' encumbered = 463'/35' = 13 children.
Classroom 109: 23'5 x 21' = 491.736'/35' = 14 children.
Classroom 110: 25' x 22' = 550'/35' = 16 children.
Classroom 111A: 45’ x 30’=1,352/35= 38 children.

Total: = 6,303 divided by 35 = 180 children

Total children toilets and sinks:
11 toilets and 4 urinals x 15 = 210 children
16 sinks x 15 = 240 children

Outdoor Activity Space Measurements:
Total= 6934' divided by 75' = 92 children

There is an appropriate fence, enclosing the playground. Shade is provided by awnings. Outdoor activity area is supplied with age and size appropriate equipment. An adequate amount of cushioning material is in place under the equipment.

Fire clearance approval letter on file and dated 04/13/2021. Based on today's inspection, facility has enough space for the requested increase capacity of 145 preschool children.

Center Director Haewon, Kim required CPR/1^st Aid training expires on 10/22.

Facility provides Incidental Medical services.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: DONG SHIN CHRISTIAN PRESCHOOL	FACILITY NUMBER: 304371100
	VISIT DATE: 06/17/2021

NARRATIVE

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In the areas evaluated, no deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12.

Facility meets all licensing requirements and file will be submitted for approval.

Exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the director. The Notice of Site Visit was posted. The director 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.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC809 (FAS) - (06/04)

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