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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370064
Report Date: 10/14/2021
Date Signed: 10/14/2021 01:46:58 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:AMERIMONT ACADEMY, INCFACILITY NUMBER:
304370064
ADMINISTRATOR:MADRIGAL, SAMANTHAFACILITY TYPE:
850
ADDRESS:490 ANAHEIM HILLS ROADTELEPHONE:
(714) 974-4664
CITY:ANAHEIM HILLSSTATE: CAZIP CODE:
92807
CAPACITY:75CENSUS: 22DATE:
10/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Samantha Madrigal TIME COMPLETED:
02:00 PM
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This is a follow-up proof of correction inspection that was made by Licensing Program Analyst (LPA) Tran. Met with Director, Samantha Madrigal who guided the analyst on a tour of the facility. Census was taken as follow: 22 preschool children with 9 staff including the director.

A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

An initial unannounced random annual visit was conducted on 09/23/2021 and a LIC 809 was completed.

The deficiencies that were previously cited on a LIC 809 dated 09/23/12 have been cleared.

LPA observed the Notice of Site Visit from the previous visit dated 9/23/2021 posted by the main entrance in the office.

The facility is within compliance of Title 22 Division 12 of the California Code of Regulations.

A notice of site visit was posted today and licensee was explained that it must remain posted for a period of 30 days. Failure to keep A Notice of Site Visit posted will result in a $100.00 civil penalty.

An exit interview was conducted and a copy of this report was provided to licensee.

“The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.”
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2841
LICENSING EVALUATOR NAME: Nguyen K TranTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
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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