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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613997
Report Date: 05/22/2023
Date Signed: 05/24/2023 08:43:13 AM


Document Has Been Signed on 05/24/2023 08:43 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:RAINBOW RISING - COLLEGE PARKFACILITY NUMBER:
300613997
ADMINISTRATOR:BUSHMAN, MARYFACILITY TYPE:
840
ADDRESS:3700 CHAPARRALTELEPHONE:
(949) 552-0366
CITY:IRVINESTATE: CAZIP CODE:
92606
CAPACITY:90CENSUS: 8DATE:
05/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Rochelle Harrell, DirectorTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPA) Mila Quinto and Aidee Nunez conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 5/18/2023. LPAs met with Director, Rochelle Harrell. LPAs observed 8 school age children with 3 staff members.

A review of staff criminal clearance records 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.

On 5/18/23, a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported on 5/16/23, a child fell from the gymnastic bar on the play structure. On 5/17/23, the director was notified by the child’s parent that child was taken to the hospital to be examined.

During today's inspection, LPA interviewed 3 staff members including the Director and 1 school age child. LPA obtained a copy of the children’s roster. Due to insufficient information available at this time, the reported incident needs further investigation.

Exit interview was conducted. The Notice of Site Visit was posted. Director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Mila QuintoTELEPHONE: (714) 293-6471
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023
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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