300613997-7-5-2023-06-CC-MQUO-CTFTAT-20230705143404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300613997
Report Date: 07/05/2023
Date Signed: 07/05/2023 02:34:13 PM

Document Has Been Signed on 07/05/2023 02:34 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	RAINBOW RISING - COLLEGE PARK		FACILITY NUMBER:	300613997
ADMINISTRATOR:	BUSHMAN, MARY		FACILITY TYPE:	840
ADDRESS:	3700 CHAPARRAL		TELEPHONE:	(949) 552-0366
CITY:	IRVINE	STATE: CA	ZIP CODE:	92606
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 90	CENSUS: 24	DATE:	07/05/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Rochelle Harrell, Director		TIME COMPLETED:	02:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Mila Quinto conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 4/18/2023. LPA met with Director, Rochelle Harrell. LPAs observed 24 school age with 3 staff. A review of staff criminal clearance 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 or exemptions. On 5/18/23, a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported on 5/16/23, Child 1 (C1) fell from the gymnastic bar on the play structure. The director was notified by the child’s parent that C1 was taken to the hospital to be examined. On 5/22/2023, LPA interviewed 3 staff members including the Director and 1 school age child. According to the director was inside the classroom when C1 came inside. Director stated gave C1 a bag of ice to place on C1’s back. Staff 1 (S1) stated was on the far side of the play structure and C1 was on the gymnastic bar structure with 2 other friends waiting in line for their turn. While S1 was attending to another child, heard someone fall and saw C1 on the ground. S1 walked up to C1 and helped C1 stand up. C1 complained of back pain. Staff 2 (S2) stated did not witness the incident as S2 was on the other side of the play structure. On 5/22/2023, LPA interviewed C1. C1 stated fell off from the gymnastic bar landing on C1's right side. C1 stated slipped from the bar as C1 did not have a good grip of the bar.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

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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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: RAINBOW RISING - COLLEGE PARK	FACILITY NUMBER: 300613997
	VISIT DATE: 07/05/2023

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On 6/26/23, LPA conducted a phone interview with Parent 1 (P1). According to P1, C1 was taken to the doctor after the incident and determined C1 sustained a fracture. However, P1 stated based on what the staff and C1 stated, there was no concern of safety or supervision as the incident was purely an accident.

LPA toured the playground and observed the playground structure were in good condition and no broken parts.

Based on the interviews conducted with staff members, P1 and C1, the facility was within compliance and no deficiency found.

Exit interview conducted and report was reviewed with the director, Rochelle Harrell. Appeal Rights and deficiencies 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.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

LIC809 (FAS) - (06/04)

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