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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418070
Report Date: 04/16/2024
Date Signed: 04/16/2024 06:28:48 PM

Document Has Been Signed on 04/16/2024 06:28 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 INFANT CENTERFACILITY NUMBER:
197418070
ADMINISTRATOR/
DIRECTOR:		MOORE, MICHELLEFACILITY TYPE:
830
ADDRESS:5403 W. PICO BOULEVARDTELEPHONE:
(323) 933-5437
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 11DATE:
04/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Artea 'Peaches" Kirkland, Facility Representative TIME VISIT/
INSPECTION COMPLETED:
06:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced annual inspection to the above facility on 04/16/2024. LPA arrived at the facility at 9:30AM, identified self and met with Artea Kirkland, Administrator, who guided analysts on a tour of the facility. LPAs provided Administrator with a copy of the LIC 125 Entrance Checklist to help facilitate the inspection. This is an infant program which consists of 2 classrooms: 1 play area and 1 sleep area. Facility operation hours are Monday to Friday from 7:00AM to 6:00 PM.

All areas identified on the Facility Sketch were inspected.
There were 11 infants and 3 staff present when LPAs arrived. The facility was observed to be within the license capacity and limitations.

At approximately 11:12AM, LPA observed license posted in a locked display case to have a licensee name of Artea Kirkland. Upon inspection, the license posted has a line over the name on the posted license that appears to have covered the name of the licensee, Michelle Moore.

Administrator was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The following was observed during the tour of the facility:
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. Infants have their own cubby to store their belongings. Infants also have their own storage for all diapering needs. --Page 1 of 5
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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 10
Document Has Been Signed on 04/16/2024 06:28 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 04/16/2024 at 04:45 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KINDER KIDS CHRISTIAN INFANT CENTER
FACILITY NUMBER: 197418070

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101160(a)
Posting of License
(a) The license shall be posted in a prominent, publicly accessible location in the center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in LPA observed license posted in a locked display case to have a licensee name of Artea Kirkland. Facility is licensed to Michelle Moore which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/16/2024
Plan of Correction
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Artea Kirkland, Administrator, was able to locate an unaltered license that has Michelle Moore as the licensee printed on the license. Administrator posted the unaltered copy of license in a locked display case that is located in a prominent area of the facility.
Type B
Section Cited
CCR
101174(a)
Disaster and Mass Casualty Plan
(a) Each licensee shall have a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in LPA did not observe the LIC610 posted. Per facility representative, Emergency Disaster Plan was not readily available which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/30/2024
Plan of Correction
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Per Administrator, a completed LIC610 will be submitted to LPA via email by POC due date.
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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


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Document Has Been Signed on 04/16/2024 06:28 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 04/16/2024 at 04:45 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KINDER KIDS CHRISTIAN INFANT CENTER
FACILITY NUMBER: 197418070

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(1)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in LPA observed foam tiles that do not interlock. LPA observed gaps between the foam tiles that can cause a tripping hazard for infants during outdoor play which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/30/2024
Plan of Correction
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Per Administrator, repairs will be made to the outdoor facility space. Photos of corrections will be submitted to LPA via email by POC due date.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 of 3 staff are missing influenza, 2 of 3 staff are missing measles, 1 of 3 staff is missing pertussis which pose a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
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Per Administrator, copies of missing immunization's will be submitted to LPA via email by POC due date.
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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 04/16/2024 06:28 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 04/16/2024 at 04:45 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KINDER KIDS CHRISTIAN INFANT CENTER
FACILITY NUMBER: 197418070

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.1(b)(1)
Teacher Qualifications and Duties
(1) A teacher shall have completed, with passing grades, at least six postsecondary semester or equivalent quarter units of the education requirement specified in (c)(1) below; or shall have obtained a Child Development Assistant Permit issued by the California Commission on Teacher Credentialing.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 of 3 staff are missing transcripts which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
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Per Administrator, copies of transcripts will be submitted to LPA via email by POC due date.
Type B
Section Cited
CCR
101415(b)
Infant Care Center Director Qualifications and Duties
(b) The experience requirement specified in Sections 101215.1(h)(1), (2) and (3) shall be completed in an infant care center or a comparable group child care program dealing with children under five years of age.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in Director's file is incomplete which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
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Per Administrator, missing documents will be submitted to LPA via email by POC due date.
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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


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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 INFANT CENTER
FACILITY NUMBER: 197418070
VISIT DATE: 04/16/2024
NARRATIVE
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LPAs discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The facility provides linens and facility has linens washed weekly or as needed. Each crib and mat are occupied by only one infant at time and cribs are kept free from all loose articles including blankets and pillows and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. Staff physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing. Documentation for infants up to 12 months includes sleeping position if it is other than on their back. LPA observed 4 of 6 files missing Individual Infant Sleeping Plan for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Staff-infant ratio requirements are being met while infants are sleeping.

All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe.

Availability of indoor drinking water was observed in classrooms. Per Administrator, older infants bring their own water bottle and water refills available with the use of water cooler system.

Disinfectants, cleaning solutions, medication and other items that are dangerous to infants, were inaccessible to infants. Administrator states that poisons are locked in the storage room. Carbon monoxide detectors were observed and are operable.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids or solid waste bags shall be discarded immediately after each meal. ---Page 2 of 5
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
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Page: 5 of 10
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 INFANT CENTER
FACILITY NUMBER: 197418070
VISIT DATE: 04/16/2024
NARRATIVE
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All floors were observed to be clean and safe. All materials accessible to infants were observed to be toxic-free.

Per Administrator, there are no firearms stored on the premises. LPAs did not observe pools or bodies of water at the facility.

Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that absorbs a fall. LPA observed foam tiles that do not interlock. LPA observed gaps between the foam tiles that can cause a tripping hazard for infants during outdoor play. There is adequate shade in the play yard. LPAs observed sun shade sails in the outdoor play yard. Per Administrator, older infants bring their own water bottle and taken outdoors. LPAs advised that no infants shall be left without the supervision of a teacher at any time.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Infant’s Records were reviewed. Inspection of required forms was made and documented on the LIC 857. During file review, LPA observed 4 of 6 infant records missing LIC9227 Infant Sleep Plan. Infant's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. The person who signs the infant in/out of the facility shall use their full legal signature and record the time of day. Infant present were signed in.

LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff present did have proof of the AB 1207 Mandated Reporter Training certificate on file. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. 3 of 3 staff are missing influenza, 2 of 3 staff are missing measles
and 1 of 3 is missing pertussis. 2 of 3 staff are missing proof of qualifications(transcripts). ---page 3 of 5
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC809 (FAS) - (06/04)
Page: 6 of 10
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 INFANT CENTER
FACILITY NUMBER: 197418070
VISIT DATE: 04/16/2024
NARRATIVE
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Menus were observed to be posted. LPA reminded Administrator that bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.

Disaster drill log was available, last drill was conducted on 04/01/2024. First Aid supplies were observed in the Director’s office and classrooms. According to Administrator, medication is only administered to an infant when accompanied with a doctor's note and is stored in the office. The facility was observed to be equipped with an isolation area for any infant who becomes ill and it is located in an area next to the facility office.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
Administrator was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The following deficiencies listed on the attached deficiencies page are being cited in accordance with California Code of Regulations Title 22.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Administrator was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. ---page 4 of 5
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
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Page: 7 of 10
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 INFANT CENTER
FACILITY NUMBER: 197418070
VISIT DATE: 04/16/2024
NARRATIVE
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A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed Artea Kirkland, Administrator.

---Page 5 of 5
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC809 (FAS) - (06/04)
Page: 8 of 10
Document Has Been Signed on 04/16/2024 06:28 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 04/16/2024 at 05:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KINDER KIDS CHRISTIAN INFANT CENTER
FACILITY NUMBER: 197418070

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101163(b)
(b) No licensee, officer or employee of a licensee shall alter a license or disseminate an altered license.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in LPA observed a license posted in a locked display case to have a licensee name of Artea Kirkland. Facility is licensed to Michelle Moore which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/16/2024
Plan of Correction
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Artea Kirkland, Administrator, was able to locate an unaltered license that has Michelle Moore as the licensee printed on the license. Administrator posted the unaltered copy of license in a locked display case that is located in a prominent area of the facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


LIC809 (FAS) - (06/04)
Page: 9 of 10
Document Has Been Signed on 04/16/2024 06:28 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 04/16/2024 at 06:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KINDER KIDS CHRISTIAN INFANT CENTER
FACILITY NUMBER: 197418070

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.2(b)(2)
(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in LPA observed LIC9227 Infant Sleep Plan missing from files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/30/2024
Plan of Correction
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Per Administrator, copies of missing documents will be submitted to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


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