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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419969
Report Date: 02/02/2024
Date Signed: 03/22/2024 11:28:54 AM

Document Has Been Signed on 03/22/2024 11:28 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GOT GAME SPORTSFACILITY NUMBER:
197419969
ADMINISTRATOR:KALMAN, KOREYFACILITY TYPE:
840
ADDRESS:408 FAIRFAX AVENUETELEPHONE:
(310) 975-8524
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY: 132TOTAL ENROLLED CHILDREN: 132CENSUS: DATE:
02/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Jensett Tubbs TIME COMPLETED:
11:11 AM
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On 03/22/2024 at 10:00 am Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced visit to provide amended report dated 02/02/2024. Upon the arrival LPA met with the Facility Representative Jensett Tubbs to whom the reason of the visit was explained .

During the visit dated on 02/02/2024 facility was issued citation due to operating in the different classroom without departments approval and fire clearance . Deficiency page was amended. Deficiency was cleared by POC visit on 03/22/2024.

Exit interview was conducted with Facility Representative Jensett Tubbs .

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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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