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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371499
Report Date: 03/18/2022
Date Signed: 03/18/2022 10:53:49 AM

Document Has Been Signed on 03/18/2022 10:53 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:KIDDIE ACADEMY OF MISSION VIEJOFACILITY NUMBER:
304371499
ADMINISTRATOR:DEMPSEY, KAYLAFACILITY TYPE:
850
ADDRESS:25521 MUIRLANDS BLVD.TELEPHONE:
(949) 380-6868
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 25DATE:
03/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Acting Administrator Ms. Anffziger, Christina &
Assistant Administrator Mr. Jimenezi-maya, Erick 		TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Desai, Ketki conducted an unannounced Case Management - Licensee initiated inspection at the facility.
Upon arrival LPA met with Acting Administrator Ms. Anffziger, Christina & Assistant Administrator,
Mr. Jimenezi-maya, Erick who requested LPA , to conduct the inspection to add the Toddler option to the Preschool License on another day due to staffing issue.

There were 25 preschool age children with 3 staff members and above staff members were in the classroom with the children providing care and supervision.

LPA shall conduct the inspection at a later day.

Exit interview held.

Notice of site visit posted.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2022
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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