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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
304371273
Report Date:
07/20/2023
Date Signed:
08/02/2023 02:51:08 PM
Document Has Been Signed on
08/02/2023 02:51 PM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
OUR SAVIOR'S LUTHERAN PRESCHOOL
FACILITY NUMBER:
304371273
ADMINISTRATOR:
RIVAS, AMY
FACILITY TYPE:
830
ADDRESS:
200 AVENIDA SAN PABLO
TELEPHONE:
(949) 492-6165
CITY:
SAN CLEMENTE
STATE:
CA
ZIP CODE:
92672
CAPACITY:
15
CENSUS:
DATE:
07/20/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:23 AM
MET WITH:
TIME COMPLETED:
10:00 AM
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SUPERVISOR'S NAME:
Patricia Magana
TELEPHONE:
(714) 703-2821
LICENSING EVALUATOR NAME:
Araceli Bootorabi
TELEPHONE:
(714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE:
07/20/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/20/2023
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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