<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418755
Report Date: 04/20/2023
Date Signed: 04/21/2023 10:48:27 AM


Document Has Been Signed on 04/21/2023 10:48 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:KIUMEHR FAMILY CHILD CAREFACILITY NUMBER:
197418755
ADMINISTRATOR:KIUMEHR, FLORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 869-9975
CITY:LOS ANGELESSTATE: CAZIP CODE:
90025
CAPACITY:12CENSUS: 7DATE:
04/20/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Flora KiumehrTIME COMPLETED:
02:30 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
On 4/20/2023, Licensing Program Analyst (LPA) Judy Laureano, conducted an unannounced Proof of Correction inspection for the purpose of verifying corrections to the Plan Of Corrections (POCs).

LPA met with , Flora Kiumehr. and explained the purpose of the visit. During today’s inspections there was 7 children with licensee providing care and supervision. Children were napping when LPA arrived.

LPA cleared 2 Plan of Corrections (POCs) violations issues on 3/8/2023 and a POC letter was generated and provided to director.

A copy of this Report (809), Appeal Rights, and Notice of Site Visit (LIC 9213) were provided to licensee , Flora Kiumehr.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1