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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371262
Report Date: 09/28/2022
Date Signed: 09/28/2022 03:13:00 PM

Document Has Been Signed on 09/28/2022 03:13 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 - MEADOW PARKFACILITY NUMBER:
304371262
ADMINISTRATOR:HUYNH, HEATHERFACILITY TYPE:
840
ADDRESS:50 BLUE LAKE S.TELEPHONE:
(949) 651-0678
CITY:IRVINESTATE: CAZIP CODE:
92614
CAPACITY: 89TOTAL ENROLLED CHILDREN: 89CENSUS: 70DATE:
09/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Hailee Ronningen, Assistant DirectorTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Valencia conducted an on site inspection for the purpose of a Case Management Incident Inspection. LPA toured the facility inside and outside, and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 70 children and 6 staff. Today's Case Management inspection is being conducted in response to a self reported incident, reported to the OC CCL office on 9/21/22, detailing a child #1 (see Confidential Names List LIC811), had sustained an injury to their left arm while swinging on an outdoor play structure. It was reported that the facility staff may have lacked supervision and could have led to the injury occurring.

During the inspection, LPA interviewed four staff directly involved in the incident, and interviewed the child #1, as well as inspected the outdoor play structure and swings where the incident had occurred. LPA reviewed the Incident Report with facility representative as well as the response of the facility. From the information LPA gathered during this inspection, LPA has determined that this incident did not occur as a result of any staff's lack or absence of supervision. The child #1 made a decision to jump from the swing and fell on their arm causing a break to the arm. This injury would not have had a different outcome had staff been closer or speaking to this child #1. In addition, it was determined from the interviews that staff had been supervising the group of children, including this child #1 when the incident had occurred. It was determined from the information available to LPA during the inspection, that the facility did not violate Supervision Title 22 Regulations, related to this incident.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. An exit interview was completed with facility representative and The report was reviewed and discussed. The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Valencia
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
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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