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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409233
Report Date: 03/09/2021
Date Signed: 03/09/2021 12:34:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:RHUMC - KID ZONE AFTER SCHOOL PROGRAMFACILITY NUMBER:
197409233
ADMINISTRATOR:GABRIELA PALACIOSFACILITY TYPE:
840
ADDRESS:26438 CRENSHAW BOULEVARDTELEPHONE:
(310) 377-6771
CITY:ROLLING HILLS ESTATESTATE: CAZIP CODE:
90274
CAPACITY:195CENSUS: 0DATE:
03/09/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Gabriela Palacios, DirectorTIME COMPLETED:
12:00 PM
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On March 9, 2021 @ 11:00 AM, an office meeting was held at El Segundo Regional Office. Present at the meeting were Licensing Program Analyst (LPA) Miriam Cohen and Gabriela Palacios, Director of RHUMC Kid Zone.

The following were discussed during the meeting:

Licensee needs assistance and guidance in properly completing LIC forms and required documentation for newly hired director of childcare center.


At the conclusion of the visit, the following areas were clarified, and the licensee is clear to adhere to the regulations pertaining to the following:

1. LIC 200A (updated application form with request for new hours of operation)
2. Required documentation for newly hired director of childcare center.

A copy of this report was discussed and issued to Gabriela Palacios, Director of RHUMC Kid Zone.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2021
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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