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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012292
Report Date: 12/30/2019
Date Signed: 12/30/2019 01:43:42 PM

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:KINDER PREP PRESCHOOL CENTERFACILITY NUMBER:
198012292
ADMINISTRATOR:EVELYN GOMEZFACILITY TYPE:
850
ADDRESS:3208 FLOWER STREETTELEPHONE:
(310) 569-9309
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:26CENSUS: 3DATE:
12/30/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Marie Johnson, LicenseeTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Rita Ramos and Monique Ayala conducted an unannounced case management inspection to the above facility. LPAs met with Angela Rivas, Teacher, who guided analysts on a our of the facility. LPAs were later met by Marie Johnson, Licensee. There were 3 children present with 2 staff upon arrival.

The purpose of the visit was to obtain a copy of the facility roster and to ensure the health and safety of children in care.

In addition, LPAs discussed the Director qualifications with the Licensee due to Licensee recently submitting documentation to the office.

There were no deficiencies cited during today's inspection.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Marie Johnson, Licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2019
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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