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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370064
Report Date: 01/30/2024
Date Signed: 01/30/2024 01:56:29 PM

Document Has Been Signed on 01/30/2024 01:56 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: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: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 51DATE:
01/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Head of School - Samantha MadrigalTIME COMPLETED:
02:20 PM
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On 01/30/24, a case management inspection was conducted today by Licensing Program Analyst (LPA) Anna Chan who met with the Head of School, Samantha Madrigal and Director Lori Macias. A self-reported incident by the facility was received at the regional office on 01/24/24 which stated that a child was locked out of the closet.

Upon arrival there were 7 staff present and 51 children in care. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During this investigation, LPA interviewed 4 staff, obtained a copy of the children attendance dated 01/18/24, Staff attendance dated 01/18/24, children’s roster, personnel report, employee write-up, LIC624, 3 documented staff statements and reviewed 2 staff files and reviewed 1 child file. LPA also obtained email copy of the videos taken on 01/18/24.

Due to insufficient information available at this time, further investigation is needed. If any deficiencies are observed, disclosed, or discovered during today’s visit, they will be addressed and cited at a later date.



Exit interview was conducted with Head of School, Samantha Madrigal. The Notice of Site Visit was posted. Head of School 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. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledge receipt of these rights. The first level appeal is to Regional Manager, address is above on the report.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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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