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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371485
Report Date: 08/25/2022
Date Signed: 08/25/2022 10:34:27 AM

Document Has Been Signed on 08/25/2022 10:34 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:GREAT FOUNDATIONS MONTESSORI-TUSTINFACILITY NUMBER:
304371485
ADMINISTRATOR:BRIONES, ANGELAFACILITY TYPE:
830
ADDRESS:15140 KENSINGTON PARK DRIVETELEPHONE:
(714) 389-2460
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
08/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Angela Briones, DirectorTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Mila Quinto conducted an unannounced Case Management visit. LPA met with Director, Angela Briones to discuss the Lead Sampling Testing conducted on 7/27/2022. Director was advised on 08/16/22 that the Lead Sample Report was to be posted. LPA confirmed that Director had posted the Lead Sample Report.

Director stated the outlet with high levels of Lead located in Room 5 is not being used. Room #5 has been vacant for more than 2 years and inaccessible to children by means of door lock. According to the Director, room 5 is in the preschool program. However, the lead sample identified the outlet under the infant program. The Director stated the outlet with high level of lead has been replaced and installed a new faucet on 8/19/22 and will be retested for Lead.

Exit interview conducted and report was reviewed with the facility representative Angela Briones. A notice of site visit was given and must remain posted for 30 days.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2022
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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