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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014220
Report Date: 10/10/2019
Date Signed: 10/10/2019 02:25:11 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:STARKIDS PRESCHOOL INC.FACILITY NUMBER:
198014220
ADMINISTRATOR:VERONICA GAWFACILITY TYPE:
850
ADDRESS:66 W. DUARTE ROADTELEPHONE:
(626) 447-9888
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:70CENSUS: 41DATE:
10/10/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Khin GawTIME COMPLETED:
02:45 PM
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Licensing Program Analysts (LPAs) Roxana Lopez and Ariel Cazares conducted a case management inspection on this date for the purpose of addressing an incident. LPAs met with Director Khin Gaw (aka Veronica) and toured the facility. There were 41 children and 7 staff present on this date.

The department received the report on 8/28/19 of an incident pertaining to Personal Rights. LPAs interviewed director, reviewed files, and gathered copies of pertinent documents related to incident. At this time additional information is needed prior to determining if a violation occurred.

Exit interview was conducted with Director Khin Gaw. A copy of this report was provided.

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.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
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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