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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414574
Report Date: 12/18/2024
Date Signed: 12/18/2024 11:04:24 AM

Document Has Been Signed on 12/18/2024 11:04 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:KIDSVILLE U.S.A.FACILITY NUMBER:
197414574
ADMINISTRATOR/
DIRECTOR:		PERERA, MAUREENFACILITY TYPE:
840
ADDRESS:8472 CORBIN AVENUETELEPHONE:
(818) 886-3508
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 57TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
12/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Maureen Perera, DirectorTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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On 12/18/2024 at 10:40 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Case Management -Other Visit. LPA identified self and met with Maureen Perera, Director and Brittany Wijesekera, Assistant Director who allowed entry into the facility and provided LPA a guided tour of the inside and outside of the facility. Upon arrival there were 0 children and 0 staff present.

The purpose of the visit was to obtain signatures on an amended report.

There were no deficiencies cited during today’s inspection.

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

A copy of this report, appeal rights, and Notice of Site Visit was provided.

Exit interview was conducted with Brittany Wijesekera, Assistant Director.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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