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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300602390
Report Date: 10/10/2024
Date Signed: 10/10/2024 01:11:06 PM

Document Has Been Signed on 10/10/2024 01:11 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MESSIAH LUTHERAN PRESCHOOLFACILITY NUMBER:
300602390
ADMINISTRATOR/
DIRECTOR:		PETINAK, REBEKAHFACILITY TYPE:
850
ADDRESS:4861 LIVERPOOLTELEPHONE:
(714) 528-8632
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 129TOTAL ENROLLED CHILDREN: 129CENSUS: 66DATE:
10/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Director Rebekah PetinakTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 10/10/24 at 11:30am, Licensing Program Analyst (LPA), Anna Chan conducted an unannounced onsite inspection for the purpose of an Annual Random Visit. LPA met with Director Rebekah Petinak and toured the facility inside and outside, and the floor and yard plan were verified. Census was taken. The overall census observed was 66 children and 11 staff. Children were having indoor and outdoor activities when LPA arrived.

During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 7:00a.m.- 5:30p.m., Monday through Friday. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. The facility provides afternoon snacks and children brings am snacks and lunches from home. Children bring sports bottles properly labeled with their names, water refill is provided by the facility through water fountain and sink.

Children nap on mats and beddings are stored individually. Sheets and blankets are brought home weekly for washing. The facility conducted an emergency drill on October 10, 2024. The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MESSIAH LUTHERAN PRESCHOOL
FACILITY NUMBER: 300602390
VISIT DATE: 10/10/2024
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The outdoor activity space was inspected for compliance. The preschool playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The playground was a cushioned by pour in place rubberized surface which appears to be enough to absorb falls. There is a paved area and sand box area in the playground. Drinking water in the outdoor activity space is provided by water fountain and refillable sports bottles with the children’s name on it. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility, and none was observed during today’s visit.

5 Staff files were reviewed for staff present during the facility inspection on this date. Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1596.7995 (a)(1) a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.
Proof of immunization against pertussis, measles for the facility were reviewed and within compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporter training, and to renew the training every two years. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 06/2026.

5 Children's records were reviewed, and there was a separate, complete, and current record for each child. Sign in and out sheet was reviewed. In the areas reviewed the children’s files were found to be in full compliance.

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. LPA verified that the lead testing was completed in 06/10/22, in accordance to the Written Directives outlined in PIN 21-21.1-CCP.


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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MESSIAH LUTHERAN PRESCHOOL
FACILITY NUMBER: 300602390
VISIT DATE: 10/10/2024
NARRATIVE
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Currently, there are medications in the facility. This facility provides Incidental Medical Services (IMS) LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Transfer Request (LIC9182). The Director was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov Site Supervisor may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

In the areas that were evaluated no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

An Inspection and exit interview were completed with Director Rebekah Petinak. The report was reviewed and discussed. Appeal Rights was discussed. The director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

The director was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.


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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC809 (FAS) - (06/04)
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