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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606172
Report Date: 10/06/2023
Date Signed: 10/06/2023 11:50:58 AM

Document Has Been Signed on 10/06/2023 11:50 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:REDEEMER LUTHERAN PRESCHOOLFACILITY NUMBER:
300606172
ADMINISTRATOR:WEISS, MELINDAFACILITY TYPE:
850
ADDRESS:16351 SPRINGDALE STTELEPHONE:
(714) 840-7117
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92649
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 8DATE:
10/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Director Mindy WeissTIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Romy Castanon conducted an unannounced case management visit due to a deficiency discovered during staff interviews. Census was taken and LPA observed 8 children and 2 staff members on the small play yard.

A review of the Facility Personnel Report Summary conducted today indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.



On 08/04/2023, during a visit to the facility, interviews with Acting Director Kristen Schouw and Preschool Board Chair Jan Flores, it was discovered that an unusual incident report LIC624 was not created and submitted. On 07/31/2023, a child sustained a head injury climbing out of the facility’s sandbox. The child was taken to the hospital as a precaution. Kristen and Jan notified Director Mindy Weiss, who was off site at the time of the incident. The incident was documented internally but there was no record of the facility reporting the incident to the Licensing Program Office.

Based on the interviews conducted with Kristen Schouw, Jan Flores and Mindy Weiss the following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101212(d)(1)(B) Reporting Requirement. The deficiency is being cited on the attached 809D.



Exit interview was conducted with Director Mindy Weiss. The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. Director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2023
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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Document Has Been Signed on 10/06/2023 11:50 AM - It Cannot Be Edited


Created By: Romelia M Castanon On 10/06/2023 at 10:49 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: REDEEMER LUTHERAN PRESCHOOL
FACILITY NUMBER: 300606172

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/13/2023
Section Cited
CCR
101212(d)(1)(B)

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101212(d)(1)(B) Reporting Requirements (d) Upon the occurrence, during the operation...(d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.(1) Events reported shall include the following... (B) Any injury to any child that requires medical treatment. This requirement is not met as evidenced by
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Director states they will follow licensing procedures to submit future incident reports. Director will also train staff (listed as designees of responsibility) of protocol and email LPA training sheet and attendance sheet by POC date.
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Based LPA interview with Director, on 07/31/2023, an incident occurred and a child sustained a head injury and was taken to the hospital. Facility documented the incident but did not report it to the local licensing agency. This is a potential risk to the health, safety or personal rights of the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Patricia Magana
LICENSING EVALUATOR NAME:Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2023


LIC809 (FAS) - (06/04)
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