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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371487
Report Date: 06/12/2023
Date Signed: 06/12/2023 02:44:53 PM


Document Has Been Signed on 06/12/2023 02:44 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: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: DATE:
06/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:KIMBROUGH, KARITIME COMPLETED:
03:30 PM
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On 06/12/2023 Licensing Program Analyst (LPA) A Bootorabi visited the facility for a self reported incident that occurred on 06/07/2023. The LPA, Bootorabi was met by the director Kari K. The LPA explained the reason for today's visit.
The census on today’s visit was as followed for classroom's toured:
Classroom 07: 23 children & 2 Teachers Classroom 08: 24 Children & 2 Teachers
Classroom 09: 13 Children & 2 Teachers Classroom 10: 22 Children & 2 Teachers

A review of the Facility Personnel Report Summary conducted on 06/12/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 06/07/2023 the facility self reported a personal right incident. The LPA interviewed Staff1 - Staff 6 (S#) during today's visit. The LPA also interviewed Child #1 (C1). A copy of the personnel roster, children roster, C1's file, and S1-S7 licensing files were requested. The LPA reviewed menus, allergy list locations, and toured the kitchen during today's visit.

Due to insufficient information available currently, the above allegation needs further investigation. Further interviews and record reviews are required. An exit interview was conducted, and the report was reviewed with the director, Kari. Appeal Rights 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. Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2023
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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