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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300604497
Report Date: 08/08/2022
Date Signed: 08/08/2022 11:08:42 AM

Document Has Been Signed on 08/08/2022 11:08 AM - It Cannot Be Edited

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:CHRIST LUTHERAN PRESCHOOLFACILITY NUMBER:
300604497
ADMINISTRATOR:LISA HOLLOWAYFACILITY TYPE:
850
ADDRESS:760 VICTORIA STREETTELEPHONE:
(949) 631-1639
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 134TOTAL ENROLLED CHILDREN: 134CENSUS: 0DATE:
08/08/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Ms. Holloway, Lisa TIME COMPLETED:
11:15 AM
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Licensing Program Analyst conducted a follow up Case management inspection to measure all the 6 Preschool rooms. It was an announced inspection. There were no children present due to Summer break. LPA met with the Director and the classrooms were measured.

Facility is now removing Room # 107 and adding Room # 115, without changing the capacity of 122 preschool age children. (
Preschool children shall use the following six rooms ( Preschool Purple stars # 108/ Preschool Red Stars# 109, Preschool Blue Stars# 110, Preschool Green Stars # 111, Preschool Yellow Stars # 115 and Preschool Orange Stars # 116) Outdoor yards remain the same.

Total Indoor Activity space : 4645'46 divided by 35 = 132'73 (133 children)

Total Toilets: 12 X 15 = 180 / Total Sinks 11 X 15 = 165

Total outdoor activity space: 12,762'40 divided by 75 = 170'17

Based on the above measurements, facility has sufficient space to accommodate 122 Preschool age children in the assigned Preschool Rooms.

New License for 122 Preschool age children in Preschool Purple stars # 108/ Preschool Red Stars# 109, Preschool Blue Stars# 110, Preschool Green Stars # 111, Preschool Yellow Stars # 115 and Preschool Orange Stars # 116 with 7 Toddler option children in new Nursery (Pink room) . (Total Capacity 129) Shall be issued upon Management approval.
Report was read and Appeal rights were presented to the facility Director.
Notice of Site visit posted.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2022
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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