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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016791
Report Date: 05/07/2024
Date Signed: 05/07/2024 01:02:28 PM

Document Has Been Signed on 05/07/2024 01:02 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:
198016791
ADMINISTRATOR/
DIRECTOR:		LUCY SALAZARFACILITY TYPE:
850
ADDRESS:456 W. SAN JOSE AVE #BTELEPHONE:
(909) 621-0226
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 27TOTAL ENROLLED CHILDREN: 15CENSUS: 10DATE:
05/07/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Anna VartevaryanTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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On 5/7/2024 at 9:10 am, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced POC (plan of correction) inspection to ensure the deficiency cited on 03/08/2024 during an annual visit has been corrected. A COVID risk assessment was conducted. LPA met with Director, Anna Vartevaryan. Director guided LPA on a tour and 10 children and 2 staff were observed during this inspection.

During the visit Director guided LPA outside who observed that the playground cushion was replaced with a brand-new absorbing material, which is located underneath the preschool playground structure. LPA took photos.

During this visit LPA also took measurements of the playground due to a previous visit. LPA observed an iron gate that divides the preschool and school-age playgrounds. (LPA took photos of the playground) Director will provide a new facility outside sketch and will send via email.
The following Measurements were taken:
OUTDOORS: 1093 sq. ft./75 sq. ft.= 14 children

LPA has advised that due to the capacity of children being a total of 27 then a waiver request will need to be submitted to the Department asking for a staggered outside play schedule for the preschool-age children.

LPA advised the Director that any physical changes to the facility require that they be notified to the Department prior to the change. LPA issued a Technical Violation advising Director of California Codes of Regulation 101237(a) Alterations to Existing Buildings or New Facilities.

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.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 ACADEMY
FACILITY NUMBER: 198016791
VISIT DATE: 05/07/2024
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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 to licensee 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: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC809 (FAS) - (06/04)
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