<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370871
Report Date: 06/21/2022
Date Signed: 06/21/2022 04:35:43 PM


Document Has Been Signed on 06/21/2022 04:35 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:A KIDS PLACEFACILITY NUMBER:
304370871
ADMINISTRATOR:PHEM, SANDYFACILITY TYPE:
840
ADDRESS:1180 SOUTH IDAHO ST. SUITE KTELEPHONE:
(714) 626-0400
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:30CENSUS: 19DATE:
06/21/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:32 PM
MET WITH:Sandy Phem, Director & Ranmal Jayasekara, Adm/OwnerTIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA ) Patricia Rivas conducted an unannounced case management visit as a result of reviewing files for an unannounced complaint visit.
Upon review of 9 files LPA found that 2 out of 9 did not have an updated mandated reporter training certificate in files. LPA found in 9 out of 9 files did not have documentation that employee rights were given.


The following deficiencies are Cited under the California Code of Regulations Title 22
(on lic 809d)

The Notice of Site Visit was posted. Facility representative/LIcensee Mr. Ranman Jayasekara was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal Rights explained. The director was provided a copy of their appeal rights (LIC 9058 01/2016) and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.

Exit interview was conducted.


SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 06/21/2022 04:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: A KIDS PLACE
FACILITY NUMBER: 304370871

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2022
Section Cited

1
2
3
4
5
6
7
Personnel Requirements
All personnel shall be informed of their rights pursuant to Sections 1596.881 and 1596.882 of the Health and Safety Code.Employees shall be notified in writing at the time of employment of their rights under this chapter, as evidenced by their signature on a notification form outlining actions protected
8
9
10
11
12
13
14
 by this section. Forms to be utilized for this
purpose shall be kept on file at the facility. This requirement was not met as evidenced by LPAs review of 9 out of 9 files did not have notification in files. This poses a potential health and safety risk to children in care
8
9
10
11
12
13
14
Type B
06/28/2022
Section Cited

1
2
3
4
5
6
7
1596.8662(4)(b)(1) On or before March 30, 2018, a person who, ..licensed child care provider, administrator, ... mandated reporter training provided pursuant to paragraphs (2) and (3) of ... mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.This requirement is not met:
8
9
10
11
12
13
14
Based on record review, Staff #1(s1) did not have certificate in file; Staff #9 's(s9) Mandated Reporter training is expired 01/08/2020. This poses a potential Health and Safety risk to the children in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2