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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418755
Report Date: 05/29/2024
Date Signed: 05/29/2024 11:24:28 AM

Document Has Been Signed on 05/29/2024 11:24 AM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:KIUMEHR FAMILY CHILD CAREFACILITY NUMBER:
197418755
ADMINISTRATOR/
DIRECTOR:		KIUMEHR, FLORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 869-9975
CITY:LOS ANGELESSTATE: CAZIP CODE:
90025
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
05/29/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Flora Kiumeher, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 5/29/2024, Licensing Program Analyst (LPA) Judy Laureano, conducted an unannounced Proof of Correction inspection for the purpose of verifying corrections were completed.

LPA met with , Flora Kiumehr and explained the purpose of the visit. During today’s inspections there was 7 children with assistant and licensee providing care and supervision.

LPA cleared 1 Plan of Corrections (POC) violations issues on 3/8/2023 and a POC letter was generated and provided to Licensee.

A copy of this Report and Notice of Site Visit was provided to Licensee F. Kiumehr.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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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