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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304371487
Report Date: 06/25/2024
Date Signed: 06/25/2024 02:16:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/03/2024 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20240503151302
FACILITY NAME:GREAT FOUNDATIONS MONTESSORI-WOODBURYFACILITY NUMBER:
304371487
ADMINISTRATOR:KIMBROUGH, KARIFACILITY TYPE:
850
ADDRESS:6304 IRVINE BLVD.TELEPHONE:
(714) 389-2400
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY:199CENSUS: 112DATE:
06/25/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Kari Kimbrough, DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not prevent child from sustaining injury.
INVESTIGATION FINDINGS:
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On 06/25/2024, Licensing Program Analyst (LPA) Tran and Jung conducted a subsequent inspection to deliver finding for the above complaint allegation. LPA Tran met with Director Kari Kimbrough. A tour of the facility was conducted, and census was taken. Observed at the time of the visit was a total of 112 preschool children and 14 staff members in 8 classrooms.

A review of the Facility Personnel Report Summary on 06/25/2024 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 05/03/2024, the Regional Office received a complaint with allegation Staff did not prevent child from sustaining injury.
(Continued next page)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 06-CC-20240503151302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GREAT FOUNDATIONS MONTESSORI-WOODBURY
FACILITY NUMBER: 304371487
VISIT DATE: 06/25/2024
NARRATIVE
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(Page 2 of Report)

During the investigation, LPA conducted interviews with 5 staff members, 4 parents and 1 child and reviewed records of the incident.

According to the incident report, Child #1 (C1) jumped off the top of the big slide structure in the playground and sustained injury on C1's left arm. During interviews, it was reported that there were two staff members on the playground supervising 22 preschool children. All interviewed staff were aware of the incident. All interviewed staff described that they were trained to position themselves on each side of the play structure to ensure they can provide supervision for the children in play. Staff #1 (S1) stated C1 was not following directions and kept jumping off the slide instead of sliding down the slide. S1 stated S1 redirected C1 multiple times prior to C1 sustaining injury on C1's arm. When interviewed, C1 stated C1 jumped a total of 4 times from the top of the small slide on the big play structure. C1 stated S1 was redirecting C1 to stop but C1 did not listen. C1 sustained injury when C1 jumped off the 4th times. Director confirmed that S1 should have redirected C1 to play in other areas or a different activity to ensure C1 can follow directions to be safe. Interviewed parents did not share concerns related to the allegation.

Based on information gathered from LPA interviews and record reviews, the preponderance of evidence standard has been met, therefore the allegation staff did not prevent child from sustaining injury, is found to be substantiated. California Code of Regulations, Title 22, Division 12 & Chapter 1, Section 101229 (a) Responsibility for Providing Care and Supervision cited on the attached LIC9099D.

Appeal Rights and deficiency were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) 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. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Kimbrough.

(End of Report)

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 06-CC-20240503151302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GREAT FOUNDATIONS MONTESSORI-WOODBURY
FACILITY NUMBER: 304371487
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/02/2024
Section Cited
CCR
101229(a)
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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs.

This requirement is not met evidenced by:
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Director states she will submit a detailed plan to ensure staff take appropriate actions to meet the children's need on the playground, to LPA by due date.
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Based on LPA interviews and record review, S1 failed to provide care and supervision as necessary to meet C1's safety needs resulting in C1's injury after jumping off the play structure multiple times. This posed a potential safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3