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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370933
Report Date: 10/05/2021
Date Signed: 10/05/2021 02:41:24 PM

Document Has Been Signed on 10/05/2021 02:41 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:RAINBOW KIDS ACADEMYFACILITY NUMBER:
304370933
ADMINISTRATOR:CYRANO ANTONYFACILITY TYPE:
850
ADDRESS:12914 HAZEL AVENUETELEPHONE:
(714) 638-8210
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 53TOTAL ENROLLED CHILDREN: 0CENSUS: 20DATE:
10/05/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Evelyn Rodriguez, Assistant DirectorTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Stacy Torrence conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 09/27/2021. LPA met with Evelyn Rodriguez, Assistant Director, LPA toured the facility. Census was taken. LPA observed 20 napping children, with three staff supervising.

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 09/27/2021 an self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that the facility’s director was stealing tuition payments/registration fees from the facility. Per licensee, the director asked new parents to pay registration and tuition fees directly to her Venmo account. During today’s visit, LPA interviewed the Assistant Director and Licensee/Owner and obtained contact information of parents involve. 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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2021
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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