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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494249
Report Date: 12/08/2021
Date Signed: 12/08/2021 01:50:03 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:KIDS KINGDOMFACILITY NUMBER:
197494249
ADMINISTRATOR:MENDOZA, TRINAFACILITY TYPE:
830
ADDRESS:731 S AVERILL AVETELEPHONE:
(310) 547-4986
CITY:SAN PEDROSTATE: CAZIP CODE:
90731
CAPACITY:12CENSUS: DATE:
12/08/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:11 PM
MET WITH:Licensee, Trina MendozaTIME COMPLETED:
01:55 PM
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On 12/8/2021, Licensing Program Analyst (LPA) Meghan McGee made an announced visit to the facility to conduct a Licensee initiated inspection. Licensee submitted a request for a waiver which will allow facility to utilize the infant room (license number 197494248) as a preschool age classroom.

LPA observed current infant room. Room is currently set up as a preschool age classroom with tables, chairs and age appropriate toys and shelving. LPA observed classroom to be free of any hazards to children in care. LPA informed Licensee to put a safety gate where the infant nap room is located so area is inaccessible to children in care.

No deficiencies cited. Exit interview was conducted with Licensee. The waiver determination of the classroom will be reviewed with Licensing Program Manager for final resolution.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Meghan McGeeTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021
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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