Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012439
Report Date: 03/30/2017
Date Signed 03/30/2017 11:27:02 AM

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:KIDZHAVENFACILITY NUMBER:
198012439
ADMINISTRATOR:CHAMPA S. PERERAFACILITY TYPE:
850
ADDRESS:9052 & 9052 1/2 SUNLAND BLVD.TELEPHONE:
(818) 767-2623
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:33CENSUS: 18DATE:
03/30/2017
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Champa S. PereraTIME COMPLETED:
09:30 AM
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Licensing Program Analyst Anomeh Eivazian conducted an unannounced POC (Plan of Correction) inspection to ensure that the Type A deficiency cited on 03/02/2017 has been cleared. Met with Champa S. Perera, Director who guided analyst tour of the facility. There were 18 children present during this inspection. The following has been observed:

During the tour of the facility LPA observed Toddler children in Toddler classroom which is physically septated from Preschool classroom . Also during this inspection LPA observed parents used the gate which is on the outdoor playground to enter the facility to drop off toddler children in toddler classroom. During this inspection toddler children did not commingled with preschool children.

Acknowledgement forms were observed for all children in care.

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



The Notice of Site Visit (LIC 9213)must remain posted for 30 days during the hours of operation after each site visit by a licensing reprehensive.
Failure to maintain posting as required will result in a civil penalty of $100.00.

LPA advised the licensee how to access forms, regulations and quarterly updated on the Child Care Licensing Website at: www.ccld.ca.gov.

LPA cleared deficiencies on this date and provided a copy of the Licensing Report to Ms. Champa S. Perera, Licensee, and issued POC clearance letter.
Exit interview was conducted with Director, Champa S. Perera. Appeal rights provided and discussed.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2017
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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