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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004772
Report Date: 06/14/2023
Date Signed: 06/14/2023 04:01:46 PM


Document Has Been Signed on 06/14/2023 04:01 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: 48DATE:
06/14/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:Kristine Manley, DirectorTIME COMPLETED:
04:30 PM
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On Wednesday, June 14, 2023, LPA Rivera conducted a Case Management deficiencies to review the corrections stated on February 2, 2023 Annual Inspection. LPA Rivera reviewed assistant director Health and Safety Certification dated 2/22/22, staff immunization records, AB 1207 Child Abuse Mandated Reporter Certifications and safe sleep logs. LPA observed the deficiencies to be corrected.

LPA Rivera cleared the deficiencies and issued the Plan of Correction Letter.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the director Kristine Manley

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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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