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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016792
Report Date: 09/21/2023
Date Signed: 09/21/2023 05:04:49 PM

Document Has Been Signed on 09/21/2023 05:04 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:KINDER KOUNTRY ACADEMYFACILITY NUMBER:
198016792
ADMINISTRATOR:LUCY SALAZARFACILITY TYPE:
840
ADDRESS:456 W. SAN JOSE AVE. #BTELEPHONE:
(909) 621-0226
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 12TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
09/21/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Anna VartevaryanTIME COMPLETED:
02:30 PM
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On 09/21/2023 Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced POC (plan of correction) inspection to ensure that deficiencies cited on 04/14/2023 have been cleared. A COVID risk assessment was conducted. LPA met with Director, Anna Vartevaryan, LPA observed 0 children present at the facility during this inspection.

LPA observed combination Smoke and Carbon Detectors installed throughout the facility and received a copy of the current staff's Mandated Reporter Certificate, which expires 9/22/2024.

LPA cleared the deficiency on this date and provided a copy of the Licensing Report to the Director. LPA also issued POC clearance letter during the visit.

At this time, the facility is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

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



Exit interview conducted and report was reviewed with the Director, Anna Vartevaryan.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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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