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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015711
Report Date: 12/03/2021
Date Signed: 12/03/2021 04:30:15 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:KIDS FIRST LEARNING CENTER - DOWNEYFACILITY NUMBER:
198015711
ADMINISTRATOR:CYNTHIA SAENZFACILITY TYPE:
850
ADDRESS:13200 COLUMBIA AVENUETELEPHONE:
(562) 803-0400
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:144CENSUS: 23DATE:
12/03/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Lizbeth AguirreTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced Case Management Incident inspection. This inspection is regarding an incident that took place on November 12, 2021. LPA met with Site Supervisor Lizbeth Aguirre who provided information and assistance during the inspection. Census was taken.

On 11/12/2021, an incident was reported to the department where a child was going up the steps of the playground structure when the child slipped on the first step causing the child to hit their bottom lip. The facility reported this incident to the Department within the required 24 hours. During this inspection LPA interviewed staff who observed the incident. Site Supervisor Lizbeth Aguirre guided LPA to the playground to observe the playground equipment where child was injured. LPA observed the equipment to be age appropriate and have no structural damage. The playground appeared to be in normal safe good condition. LPA obtained and reviewed documentation. Based on the information obtained and LPA observation of the play area, LPA determined there was adequate supervision provided the day of the incident.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview conducted with Lizbeth Aguirre.


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: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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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