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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312897
Report Date: 11/19/2024
Date Signed: 11/19/2024 04:02:09 PM

Document Has Been Signed on 11/19/2024 04:02 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:KELLY, MATTHEW DEANFACILITY NUMBER:
304312897
ADMINISTRATOR/
DIRECTOR:
KELLY, MATTHEW DEANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 624-3780
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
11/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:08 PM
MET WITH:Licensee, Matthew Kelly TIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA), Aiddee Nunez in response to a self-reported incident dated 11/12/24. Present during today’s inspection was the Licensee, Matthew Kelly. The overall census observed were 4 school age children and 1 assistant. A review of adult records 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 11/12/2024 an Unusual Incident Report was filed with the Department to self-report an incident that the occurred date is unknown. Licensee reported that a parent came across a video while looking at their child’s tablet at home. The video showed Child#1 (C1) pulling down their pants and Child#2 (C2) putting a ruler between C1’s bare butt cheeks. Licensee stated that C1 and C2 were hiding from licensee’s view.

During today’s visit LPA interview licensee and 4 children.


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. Licensee, Matthew Kelly 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.

End of Report.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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