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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492945
Report Date: 06/28/2022
Date Signed: 06/28/2022 10:01:06 AM


Document Has Been Signed on 06/28/2022 10:01 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:KIDS TOWN CHILDCARE CENTER, LLCFACILITY NUMBER:
197492945
ADMINISTRATOR:JESSICA DONISFACILITY TYPE:
840
ADDRESS:1825 WEST AVENUE J, SUITE 125TELEPHONE:
(661) 951-2070
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:45CENSUS: 12DATE:
06/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Nancy Ramirez-Ruiz, Asst. DirectorTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Maddox met with Nancy Ramirez-Ruiz, Asst. Director for the purpose of conducting a Case Management inspection.

The purpose of the visit was to conduct a Health and Safety check. Present at time of inspection were 12 children and 1 staff, ratio's were within State regulatory guidelines. During this unannounced inspection, LPA interviewed 5 SA children (names recorded on LIC 811 - Confidential Names List).


Exit interview conducted and a copy of report left with Asst. Director.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022
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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