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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004772
Report Date: 05/09/2025
Date Signed: 05/09/2025 04:32:31 PM

Document Has Been Signed on 05/09/2025 04:32 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:COUNTY KIDS' PLACEFACILITY NUMBER:
198004772
ADMINISTRATOR/
DIRECTOR:		MANLEY, KRISTINEFACILITY TYPE:
850
ADDRESS:2916 HOPE ST.TELEPHONE:
(213) 699-7340
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 59TOTAL ENROLLED CHILDREN: 64CENSUS: 52DATE:
05/09/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Kristine Manley, DirectorTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analysts (LPAs) Franchesca White and Linda Voong arrived at the above facility for the purpose of an unannounced Case Management - Incident inspection. LPA Voong announced the purpose of the visit and was granted entry into the facility by Assistant Director Maria Luna. Census was taken. All staff have current criminal background clearance.

The purpose of today's visit is to follow up on an Unusual Incident Report received to the department on May 1, 2025. Around 4:40pm, Child 1 (C1) and classmates were outside playing. C1 was running to the other side of the playground and tripped and fell and landed on table outside. C1 hit face on table, leaving a cut on right eyelid. Staff 1 (S1) treated the bleeding and put ice pack on injured area. Upon pick up, parent stated that C1 will be taken to doctor. S1 put cold compression to stop bleeding. Once bleeding stopped, S1 placed butterfly bandage on wound. Ice pack was also provided. S1 contacted parent to inform of incident and parent picked C1 at 5:40pm. C1 did not return on 5/1/25.

At 1:55, Director Kristine Manely gave LPAs a tour of the outdoor play area, and showed LPAs where the incident occurred.
Based on interview with director Kristine, C1 required medical attention. C1 returned to school on 5/2/2025. Based on interviews with S1 and S2, C1 was transitioning back into the classroom and tripped on an uneven area of the soft play yard and bumped her head on the plastic table causing a cut over the right eyelid. S2 states that she witnessed the incident occur, and S1 assisted in providing first aid to the child.

...............................................Report Continues 1 of 2 Pages.................................................................
Denise GibbsTELEPHONE: (323) 981-3385
Franchesca WhiteTELEPHONE: 323-981-3350
DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2025
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 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: COUNTY KIDS' PLACE
FACILITY NUMBER: 198004772
VISIT DATE: 05/09/2025
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LPAs discussed the following recommendations to minimize the frequency of incidents on the playground with Director Kristine and Assistant Director Maria Luna:
  • Consider consulting with County Maintenance and Grounds to level the area of grass where the child fell.
  • Speak with staff on safe methods for transitioning the children from outside to indoor play using walking feet.
  • Place the table over the uneven area until repair can be scheduled.
LPAs discussed best practices in reporting requirements, and documentation of incident reports.

Director states that they will provide training to staff and send a copy of the meeting agenda signed by all employees/attendees to LPA Voong on or before May 30, 2025. Email can be sent to linda.voong@dss.ca.gov

LPA White stated that a video link on Active Supervision will be sent to the director on or before May 16, 2025.

Based on today's observations, interviews, and record review there will be no deficiencies cited today in accordance with California Title 22 regulations.

A notice of site visit was given and must be posted for 30 days. Failure to post will result in a $100 civil penalty.

A copy of the report and appeal rights was given to Director Kristine Manley.

..........................................................Report Ends 2 of 2 Pages..................................................................
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Franchesca WhiteTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC809 (FAS) - (06/04)
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