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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004773
Report Date: 06/14/2023
Date Signed: 06/14/2023 04:01:02 PM


Document Has Been Signed on 06/14/2023 04:01 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:COUNTY KIDS' PLACEFACILITY NUMBER:
198004773
ADMINISTRATOR:RODRIQUEZ, ELVIAFACILITY TYPE:
830
ADDRESS:2916 HOPE STREETTELEPHONE:
(213) 744-6241
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY:12CENSUS: 8DATE:
06/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Kristine Manley, DirectorTIME COMPLETED:
10:55 AM
NARRATIVE
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On Wednesday, June 14, 2023 at 9:54 am, LPA Rivera arrived at the facility, to conduct an investigation in regards a complaint the department received on June 8, 2023. During the review of the files, LPA observed staff 1 and staff 2 not being associated nor having a background clearance. LPA informed director Kristine, due to staff 1 and staff 2 not having a background clearance, they cannot be present at the facility and must be removed. Director, removed staff 1 and staff 2 and informed them that they need to go and do their live scan.

The deficiency listed on the following page was observed by the LPA Rivera and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

The licensee shall post licensing report documenting a type “A” citation. In addition to posting this report, the licensee will also provide LIC 9224 Acknowledgement of Receipt of Licensing Reports to the parents of the children in care and any newly enrolled children for up to one year. The notice of site visit must be posted for 30 days upon receipt and appeal rights were given and explained. The content of this report was read and discussed. An exit interview was conducted with Director Kristine Manley.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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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Document Has Been Signed on 06/14/2023 04:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: COUNTY KIDS' PLACE
FACILITY NUMBER: 198004773

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2023
Section Cited
CCR
101179(e)(1)

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California 101170 Criminal Record Clearance (e) (1) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility
This requirement was not met as evidenced by:
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Director removed staff 1 and 2 from facility and sent them to go and do their Live Scan and informed staff that they cannot return to the facility until the facility receives the Clearance Letter.
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Based on record review, staff 1 and staff 2 did not obtained a criminal record clearance.
This poses an immediate Health, Safety, or Personal Rights risk to children in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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