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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016461
Report Date: 09/21/2023
Date Signed: 09/21/2023 12:53:10 PM


Document Has Been Signed on 09/21/2023 12:53 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:KIDS FORUM PRESCHOOLFACILITY NUMBER:
198016461
ADMINISTRATOR:JANET TORRESFACILITY TYPE:
850
ADDRESS:4523 TWEEDY BLVD.TELEPHONE:
(323) 563-6568
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:50CENSUS: 6DATE:
09/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Janet TorresTIME COMPLETED:
01:00 PM
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On 9/21/23, Licensing Program Analyst, T. Tran arrived at the above facility for the purpose of amending the LIC9099A that was provided on 9/7/23. LPA met with Center Director, Janet Torres.

No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Janet Torres.

SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023
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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