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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370365
Report Date: 11/17/2022
Date Signed: 11/28/2022 09:09:58 AM

Document Has Been Signed on 11/28/2022 09:09 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:MAXWELL SCHOOL READINESSFACILITY NUMBER:
304370365
ADMINISTRATOR:LOPEZ, REINAFACILITY TYPE:
850
ADDRESS:2613 W. ORANGETELEPHONE:
(714) 527-2154
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 21DATE:
11/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Coordinator of School Readiness, Ama HolmesTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Romy Castanon conducted a case management inspection to follow up on a self reported unusual incident that was submitted to CCL Regional Licensing Office on 10/14/2022. It was reported via telephone by Coordinator of School Readiness, Ama Holmes and sent by fax on 10/17/2022. Per Mrs. Holmes, the unusual incident occurred on 10/11/2022.

During today's inspection a tour of the facility was conducted. There were 21 children on the playground with 3 staff. A review of staff 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

LPA interviewed Mrs. Holmes who conducted the facility’s internal investigation. At 11:00am on 10/11/2022, as students were preparing for dismissal, Child #1 (C1) destroyed another child’s arts & crafts jewelry by gripping their hand on their shirt collar. Teacher Reina Lopez (T1) intervened to separate both children. T1 held C1’s left hand, with her right hand. T1 already had another child holding her left hand. At this time, C1 was visibly upset and crying. Mrs. Holmes stated C1 was “thrashing his body around”. T1 stepped back with both children and stood against the classroom bungalow, behind the entrance gate. T1 waits for children to be called and signed out by parents before walking them to the gate. C1 continued to thrash his body and dropped his weight down to the floor. C1’s Grandmother approached the gate and witnessed C1 crying. T1 allowed Grandma inside the gate to discuss C1’s behavior. Grandma asked C1 what happened and who did it. C1 pointed to T1. Grandma became visibly upset stating “I’m done, I’m done” and walked away without speaking to staff. LPA also interviewed T1 who mentioned that this was typical behavior from C1. T1 was always in communication with Grandma regarding C1 eloping and hitting others. LPA toured the facility and the incident location. LPA noticed the baseboard moldings on bungalow is not flush with the wall and protrudes about 1 ½ - 2 inches.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MAXWELL SCHOOL READINESS
FACILITY NUMBER: 304370365
VISIT DATE: 11/17/2022
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A formal complaint was submitted to the Magnolia School District regarding this incident from C1’s Mother. Mrs. Holmes stated a request was made from Mom to be transferred to another program. C1 started new program at Juliette Low Elementary School on 10/21/2022.

Based on LPA observations, interviews conducted, and records/documentation reviewed, there is no evidence to support any violation of Title 22 regulations. No Title 22 deficiencies cited during today's inspection.

Exit interview was conducted with Coordinator of School Readiness, Ama Holmes. The Notice of Site Visit was posted. Mrs. Holmes was advised the Notice of Site Visit must be posted for 30 days or $100 Civil Penalty will be assessed.

(End of Report)

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC809 (FAS) - (06/04)
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