<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371522
Report Date: 10/21/2021
Date Signed: 10/21/2021 03:48:33 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:CROSSLINE CHRISTIAN PRESCHOOLFACILITY NUMBER:
304371522
ADMINISTRATOR:STARK, MICHELEFACILITY TYPE:
850
ADDRESS:23331 MOULTON PKWYTELEPHONE:
(714) 646-4285
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:84CENSUS: 0DATE:
10/21/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Ms. Stark, Michele & Church Representative Ms. Carrasco, Marci TIME COMPLETED:
01:00 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
Licensing Program Analyst (LPA) Ms. Ketki Desai conducted an announced on site pre-licensing inspection at the childcare center. It is a New facility and Facility Administrator Ms. Stark , Michele and Church Representative Ms. Carrasco, Marci who gave a tour of the Child Care Center. The applicant has requested to provide care and supervision for 84 Pre-school age children 2 to 6 years of age, Monday through Friday 7:00 AM-6:00PM (Full day session) and 8:00 AM -12:00PM (Half day session) in the assigned seven classrooms. Due to COVID 19, LPA observed representatives wearing face mask, social distancing and following CDC and Dept of Public Health Guidelines.

Due to COVID Pandemic parents shall be encouraged to follow the CDC and COVID requirements, children shall be received at the entrance door by the staff, temperatures shall be checked, hands sanitized before they are taken to their classrooms. Parents sign them in at the front lobby electronically.

A review of the Facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility is located on the Church grounds (Education center building) there is parking lot in front of the building, parents shall access the building with two entrance gates, parents with younger infants shall access the gate on the lower level while older children parents shall walk up the steps to the lobby area to gain access to the classroom. Sign in procedure is a digital application where parents can use their phones, as well as I-Pads, which are placed in each room for electronic sign in's.

There are two levels in the Education center building: first level has two preschool rooms while the 5 Preschool rooms are on the second level.
(Page-1)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 6
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: CROSSLINE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 304371522
VISIT DATE: 10/21/2021
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
26
27
28
29
30
31
32
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. 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

Medication will be stored in the Director's office in a locked cabinet and shall be administered by the teacher or the Facility in charge, emergency First Aid kits are stored in the classrooms and in the in assigned cabinets. Medication administration forms were reviewed.
Isolation area is the Director’s office and the sick child shall use the restroom located next to the lobby area there is an additional mat and linens for the sick child.

The following were inspected in the indoor activity space:
· Classroom are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside through personalized water bottles and it shall be refilled as needed.
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Electronic sign in and out)
· There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements.
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· Napping equipment: Urban Infant roll up mats are used and are stored at the end of the classroom, napping linens and blankets are provided by the parents.
· Facility provides two snacks and lunch is brought from home. Containers shall be stored and labeled accordingly

LPA discussed the posting requirements including, but limited to, the following:
· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610)
· Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393) (Page-2)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: CROSSLINE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 304371522
VISIT DATE: 10/21/2021
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
26
27
28
29
30
31
32
· Personal Rights (LIC 613A)
· Menus / Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies / Plan of Corrections of Type A deficiencies
· Granted Waivers (available for review)
· Child Car Seat Law (PUB 269)
· COVID Posters.

Indoor measurements : 7 Preschool rooms

Room Identification LengthWidth
Area
Encumbered
Space
Room # 4 (Preschool)
25.25
12.5
315.63
14.10
301.53
Room # 5 (Preschool)
24.33
23
559.59
14.10
301.53
Room # 6(Preschool)
24.42
23.17
565.81
14.10
551.71
Room # 7(Preschool)
28
24.42
683.76
6.32
677.44
Room # 8 (Preschool)
24.33
21.25
517.01
6.32
510.69
Room # 9 (Preschool)
24.42
23.5
573.87
14.10
559.77
Room # 10 (Preschool)
25.5
24.58
626.79
14.1
612.69

Total indoor space : 3515'36 divided by 35 = 100’44 ( 100 children)

Total sinks : 14 X 15= 210 children


Total Toilets/ Urinals: 16 X 15= 240 children

Facility has gender designated toilets on each level, for Preschool children and Room # 4,5,6 and 9 have one toilet inside the classroom (younger preschool children) along with the sink. Both sinks and toilets were age appropriate for younger preschool children.

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: CROSSLINE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 304371522
VISIT DATE: 10/21/2021
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
26
27
28
29
30
31
32
Preschool outdoor play yards : Facility has designated Preschool yards and the measurements are as follows

AREA IDENTIFICATION LENGTHWIDTH
AREA
ENCUMBERED
SPACE
Cemented lunch area
48.25
39.33
1897.67
1897.67
Green turf area
83.33
45
3749.85
3749.85
Back small area
20.58
18.17
373.94
373.94
Bike trail area
34.67
28.75
996.76
996.76

Total outdoor space : 7018'22 Sq Ft divided by 75= 93'58 (94 children)

The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by personalized water bottles
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures and outdoor activity toys,
· An adequate amount of cushioning material consisting soft cushion is in place under the play structures
· Adequate shade is provided by shaded structure (Canopy)and umbrella's are placed.
· There is also a bike trail area and a cemented open area for children to play

Based on the indoor and outdoor measurements, sink and toilet availability, facility has enough space to accommodate 84 Preschool children ( 2-6 years old) in the assigned seven classrooms.

Fire clearance received from Orange County Fire Authority approving the requested capacity of 112 children
(Includes 28 infants) in the ten assigned rooms in the Education center building.

Facility Administrator is current on the required Immunization/ Pediatric CPR/ First training valid through July 21/2022 and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component (Page-4)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: CROSSLINE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 304371522
VISIT DATE: 10/21/2021
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
26
27
28
29
30
31
32
The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf

Applicant was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to down load forms, Title 22 regulations, and training's on-line at www.ccld.ca.gov. The applicant was also informed to visit the website for Quarterly Updates. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: 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. Facility has access to the new system.

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The applicant/facility representative was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness

The facility was following Title 22 requirements at the time of the inspection. Based on today’s measurements, and the sink and toilet availability, this center has enough activity space to support the capacity of 84 Preschool children in Room # 4,5,6,7,8, 9, and 10

A license will be issued for the capacity of 84 preschool children age 2-6 years old, in the above rooms Monday to Friday 6:00AM to 7:00PM after a final review. The applicant will be notified if any additional information is required.

Applicant was also advised, once licensed, the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed, and the report shall posted and copies provided to the parents/guardians of the children in care at the facility by the next business day, (Page-5)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: CROSSLINE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 304371522
VISIT DATE: 10/21/2021
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
26
27
28
29
30
31
32
and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file

The report was reviewed and discussed.

An exit interview was completed with the facility Administrator Ms. Stark, Michele and Church Representative Carrasco, Marci.


Appeal Rights were discussed. The applicant was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6