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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016797
Report Date: 08/03/2022
Date Signed: 08/03/2022 04:12:24 PM

Document Has Been Signed on 08/03/2022 04:12 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:KING'S KIDS PRESCHOOLFACILITY NUMBER:
198016797
ADMINISTRATOR:MUN HEEFACILITY TYPE:
850
ADDRESS:18424 S. BLOOMFIELD AVENUETELEPHONE:
(562) 417-6565
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 71TOTAL ENROLLED CHILDREN: 46CENSUS: 33DATE:
08/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Ha Jeong Lee, Assistant DirectorTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) T. Tran conducted an unannounced Case Management Incident visit at King’s Kids Preschool to follow up a self-reported incident occurred on 07/20/2022 regarded a child fell during outdoor play. The Monterey Park South West Office received the writing report on 07/21/2022. LPA met with Ha Jeong Lee, Assistant Director. During today’s visit, LPA observed proper care and supervision.

LPA completed child and staff’s files review. LPA obtained child's document. Interviews were conducted with staff, children, and other. On the day of the incident, there was a staff supervised five children during outdoor play. Parent was notified immediately. Based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Ha Jeong Lee.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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