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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018141
Report Date: 05/21/2019
Date Signed: 05/23/2019 11:20:22 AM

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:TOP KIDS - SCHOOL AGE CCFACILITY NUMBER:
198018141
ADMINISTRATOR:YIP, MONIQUEFACILITY TYPE:
840
ADDRESS:600 E. GRAND AVETELEPHONE:
(626) 285-1988
CITY:SAN GABRIELSTATE: CAZIP CODE:
91776
CAPACITY:61CENSUS: 26DATE:
05/21/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Charlotte Cam TIME COMPLETED:
04:00 PM
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LPA Seung Lee arrived and spoked to staff member Charlotte Cam who stated she was the assistant. LPA Lee explained the reason for the inspection. The staff member gave a phone to LPA Lee and Director Monique Yip stated over the phone that the school age children observed were part of the Heritage Program. The staff member provided LPA Lee a copy of the Heritage license verification. LPA Lee advised the Director that she should submit something in writing to close out the school age license since the age group under the school age license are all part of the heritage license. Due to FAS error the facility representative was given a copy of the following 809s form. Both copies were signed by the LPA and facility representative. An official report from FAS will be mailed to the facility at a later date.

Exit interview conducted with Charlotte Cam.
SUPERVISOR'S NAME: Guangorena ClaudiaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
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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