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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004772
Report Date: 02/17/2023
Date Signed: 02/17/2023 05:17:50 PM


Document Has Been Signed on 02/17/2023 05:17 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:COUNTY KIDS' PLACEFACILITY NUMBER:
198004772
ADMINISTRATOR:MARTINEZ, EDITHFACILITY TYPE:
850
ADDRESS:2916 HOPE ST.TELEPHONE:
(213) 744-6241
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY:59CENSUS: 24DATE:
02/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:27 PM
MET WITH:Maria Luna, Assistant DirectorTIME COMPLETED:
05:15 PM
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On Friday, February 17, 2023 at 3:27 p.m., Licensing Program Analyst (LPA) Mayra Rivera conducted a Case Management inspection at the above facility to follow up on the self reported incident that occurred on 2/2/23 in staff assisting a child with asthma inhaler . LPA met with Health and Safety Coordinator Denise Isidro who guided LPA on a tour of the facility. At approximately 3:38 p.m. LPA entered classroom Preschool and LPA observed 10 children with staff #1. At approximately 3:42 p.m., LPA entered classroom Discovery and observed 9 children with Staff #2 and at approximately 3:48 p.m., LPA entered classroom Prek and observed 14 children with staff #3 and #4.

LPA Rivera observed Medication Authorization form completed by parent authorizing KinderCare Education staff to administer the following prescription medication Albuteral Sulfate to child #1. Medication authorization dosage states 2 puffs 4 hours or as needed. LPA observed the medication record log and observed date 2/2/23, at 4:25 p.m., Albuterol Sulfate 2 puffs and staff signature. LPA reviewed the medication and observed the medication to expire on February 2024. LPA interviewed staff and reviewed documentation to determine whether or not a violation occurred.

Base on the information provided and documents reviewed, the facility followed procedures to ensure child received first aid, and followed the medication authorization instructions. Therefore, LPA Rivera determined there to be no violation of Tittle 22.

Upon receipt, Notice of Site Visit shall be posted for thirty (30) consecutive days where the parent/guardian of children enter and exit the facility Failure to maintain posting as required will result in a $100 civil penalty.

Exit interview conducted with Assistant Director Maria Luna and appeal rights were provided and explained.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2023
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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