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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416529
Report Date: 06/20/2024
Date Signed: 06/20/2024 03:40:49 PM


Document Has Been Signed on 06/20/2024 03:40 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:KINDER KIDS CHRISTIAN PRESCHOOLFACILITY NUMBER:
197416529
ADMINISTRATOR:SMITH, BRENDAFACILITY TYPE:
850
ADDRESS:5353 W. PICO BOULEVARDTELEPHONE:
(323) 933-5437
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY:67CENSUS: 20DATE:
06/20/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Michelle MooreTIME COMPLETED:
03:50 PM
NARRATIVE
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On 6/20/24 at 8:10 AM, LPA Jeanine Lipsey met with Director Michelle Moore for the purpose of an unannounced Case Management - Deficiencies visit. Upon entry, LPA Lipsey observed 20 children, being supervised by 3 staff members.
Upon review of the employee roster, Guardian, and interview of the teacher Kyra Bacon, who disclosed that Ms Page hired her sometime in Oct of 2023. The personnel roster Date of employee reads 12/4/23.

The staff has been working, residing or volunteering at the facility without a clearance transfer. Date of hire was 12/4/23. Director filled out LIC 9821 to have staff associated today to become into compliance.

Based on today's observation, today's violation will be assessed a civil penalty. See attached LIC 809D.

On 6/20/24, a Civil Penalty of $500 was assessed due this violation. See LIC 421BG

Exit interview conducted and report was reviewed with Director, Michelle Moore. A copy of this report, along with Appeal Rights, were provided.  A Notice of Site Visit was given and must remain posted for 30 days. 
SUPERVISOR'S NAME: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Jeanine LipseyTELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024
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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Document Has Been Signed on 06/20/2024 03:40 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: KINDER KIDS CHRISTIAN PRESCHOOL
FACILITY NUMBER: 197416529

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2024
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance

All individuals subject to a criminal record review shall, prior to working, a licensed facility:Request a transfer of a criminal record clearance as specified ...
This requirement is not met by evidence by
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Director filled out lic 9281 to associate the staff today to become into compliance.
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 Based on record review, the licensee did not ensure Kyra Bacon (date of hire 12/4/23) was not associated to the facility which poses a potenial health, safety, or personal rights risk to persons in care. A civil penalty of $500 has been assessed.
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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: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Jeanine LipseyTELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024
LIC809 (FAS) - (06/04)
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