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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371487
Report Date: 10/31/2022
Date Signed: 10/31/2022 10:51:50 AM

Document Has Been Signed on 10/31/2022 10:51 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-WOODBURYFACILITY NUMBER:
304371487
ADMINISTRATOR:KIMBROUGH, KARIFACILITY TYPE:
850
ADDRESS:6304 IRVINE BLVD.TELEPHONE:
(714) 389-2400
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY: 199TOTAL ENROLLED CHILDREN: 199CENSUS: 72DATE:
10/31/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:21 AM
MET WITH:Kari Kimbrough, Director TIME COMPLETED:
11:00 AM
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On 10/31/2022 Licensing Program Analyst (LPA) Stella Gutierrez made an unannounced visit to the facility for the purpose of a self reported incident that occurred on 10/13/2022. LPA, Gutierrez was met by the director who was explained the reason for today's visit. LPA observed 20 Pre-school staff and 72 Preschool children.
A review of the Facility Personnel Report Summary conducted on 10/31/2022 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 10/13/2022 an authorized representative informed the director that their child stated that a staff in classroom #9 slapped their hand while in care on 10/13/2022.

On 10/25/2022 Parent and director reviewed video footage in the 2s classroom #9 on 10/13/2022. Director and Parent were interviewed regarding the footage observed and it was stated by both that the only incident that occurred in Classroom #9 on 10/13/2022 was that Staff #1 took a marker out of child's hand without asking for it. LPA, Gutierrez could not qualify child to interview. Since the incident occurred child has been transitioned from Classroom #9 to Classroom #8 per request of the parent. LPA, Gutierrez reviewed video footage during today's visit. LPA, Gutierrez observed Staff #1 take a marker from Child's right hand while holding child's other hand in a non-aggressive manner.
Based on interviews and video footage there are no citations being issued.
Exit interview conducted and report was reviewed with the director, Kari Kimbrough. 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.
A 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. Page 1 of 1
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2022
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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