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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300604497
Report Date: 08/11/2026
Date Signed: 08/11/2026 02:33:04 PM

Document Has Been Signed on 08/11/2026 02:33 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:CHRIST LUTHERAN PRESCHOOLFACILITY NUMBER:
300604497
ADMINISTRATOR/
DIRECTOR:		EMILY MARTINEZFACILITY TYPE:
850
ADDRESS:760 VICTORIA STREETTELEPHONE:
(949) 631-1639
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 129TOTAL ENROLLED CHILDREN: 129CENSUS: 0DATE:
08/11/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Facility Representative, Emily MartinezTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 08/11/2026, Licensing Program Analyst (LPA), Deschampe entered the facility at 1:15PM for an unannounced case management - licensee initiated inspection for the purpose of an increased capacity request. LPA met with the facility representative/director (FR), Emily Martinez. The facility is currently licensed to serve Monday-Friday, 6:30AM - 6:30PM, 129 children ages 2-6 years in rooms: 108/Purple, 109/Red, 110/Blue, 111/Green, 115/Yellow, 116/Orange, including 7 toddler option children ages 18-36 months in Nursery/Pink Room. Total census at the time of the inspection was 0 children, due to summer break and 4 staff.

A review of the Facility Personnel Report Summary on this date, 08/11/2026 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility has requested a capacity increase from 7 toddler option children to 18 toddler option children, by re-licensing Room 107/Yellow Stars. The facility has requested to provide care and supervision for 122 preschool children in Rooms 108/Purple, 109/Red, 110/Blue, 111/Green, 115/Yellow, and 116/Orange with 18 additional toddler option children ages 18-36 months in Nursery/Pink Room and Room 107/Yellow Stars, from 6:30AM-6:30PM Monday0Friday.

LPA confirmed measurement of 2 rooms today (Pink Room and Room 107/Pink Room). Total indoor activity space measured at 1076 square feet (measured by LPA K. Desai on 08/04/2022 and LPA Malek on
Thuy Ho
Susan Deschampe
DATE: 08/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2026
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 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: CHRIST LUTHERAN PRESCHOOL
FACILITY NUMBER: 300604497
VISIT DATE: 08/11/2026
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08/19/2015), which is sufficient to accommodate the requested overall capacity of 18 toddler children (18-36
months of age). There are no bodies of water or weapons on the property. LPA observed a total of 10 sinks and 12 toilets available to children. Staff bathrooms are separate and sufficient. Room 107/Yellow Stars are equipped with a potty chair, changing table and a sink within arm's reach. Nursery/Pink Room has 1 toilet, 1 changing table and a sink within arm's reach.

The outdoor space for toddler children was inspected. The total toddler outdoor space was measured at 3746 square feet in addition to the total preschool outdoor space, measured at 9016 square feet (measured by LPA K. Desai on 08/04/2022 and 08/08/2022), which accommodates 18 toddler children and 122 preschool children, respectively. The playgrounds are fully fenced. The surface of the toddler playground is artificial grass. Shade is provided in all playgrounds. There are sufficient outdoor age-appropriate toys and play equipment available.

Based on today's measurement of indoor/outdoor space, and number of sinks and toilets/potty chair(s), the facility meets the requirements for the capacity of 122 preschool children (2-6 years old) in rooms 108/Purple, 109/Red, 110/Blue, 111/Green, 115/Yellow, and 116/Orange, and 18 toddler children (18-36 months of age) in Nursery/Pink Room and Room 107/Yellow Stars. The facility will be granted the increased total capacity of 140 preschool children, including toddler option, upon final review and approval from management. No deficiencies observed during today's inspection.

LPA and FR discussed the waiver request to address the rotations of preschool classrooms on the preschool playground. FR submitted the waiver request letter, preschool schedules, and LIC500 Personnel Report via email during today's inspection.

An exit interview was conducted with Facility Representative, Emily Martinez. Notice of Site Visit was posted during the visit. The facility representative was informed that the notice of the site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The “Notice of Site Visit” must be posted on, or immediately adjacent to, the interior side of the main door to the facility.

End of report.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026
LIC809 (FAS) - (06/04)
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