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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845644
Report Date: 10/29/2024
Date Signed: 10/29/2024 11:13:48 AM

Document Has Been Signed on 10/29/2024 11:13 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINGSTON ACADEMYFACILITY NUMBER:
334845644
ADMINISTRATOR/
DIRECTOR:		KAREN BRAZZILLFACILITY TYPE:
850
ADDRESS:6048 ETIWANDA AVENUETELEPHONE:
(951) 681-4182
CITY:MIRA LOMASTATE: CAZIP CODE:
91752
CAPACITY: 72TOTAL ENROLLED CHILDREN: 20CENSUS: 7DATE:
10/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:44 AM
MET WITH:Lead Teacher Denese Keeler and Director Karen BrazzillTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On the above date and time Licensing Program Analysts (LPAs) Susan Brewer and Patricia Berry, arrived at the facility for a separate matter of a complaint investigation. LPAs were greeted and granted entry into the facility by Lead Teacher Denese Keeler. The Lead Teacher Denese Keeler, stated the Director Karen Brazzill and Owner Hanbo Liang were away from the facility. The LPAs took a census of 7 children in care.

D. Keeler, stated the LPA Susan Brewer and LPA Aman Lama (not present) are no longer welcome to the facility and need to leave the facility, however LPA Patricia Berry is allowed to remain at the facility. LPAs informed D. Keeler of the inspection authority, Title 22 regulation section 101200(a)(1). The Lead Teacher D. Keeler, stated the Director Karen Brazzill and Owner Hanbo Liang, were on speaker phone to ensure the LPA S. Brewer was escorted out of the facility. The lead teacher D. Keeler stated the owners will accept the civil penalty and knew their rights.

LPAs Susan Brewer and Patricia Berry, informed Lead Teacher Denese Keeler that this report dated 10/29/2024 documents a Type A citation, under Title 22 regulation, section 101200(a)(1) Inspection Authority of the department which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs Susan Brewer and Patricia Berry informed the D. Keeler to provide a copy of this licensing report dated 10/29/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

See LIC809C Page 2
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845644
VISIT DATE: 10/29/2024
NARRATIVE
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IF a Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

A Type A violation was issued for Title 22 regulation, section 101200 (a)(1) Inspection Authority of the Department,



An immediate civil penalty was issued in the amount of $500.00.

At 10:22 AM Director K. Brazzill arrived at the facility and concluded the visit.

Exit interview conducted and report was reviewed with Lead Teacher Denese Keeler and Director Karen Brazzill.

A Notice of Site Visit was given and must remain posted for 30 days.

The LPAs verified the Notice of Site Visit was posted prior to exiting the facility.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/29/2024 11:13 AM - It Cannot Be Edited


Created By: Susan Brewer On 10/29/2024 at 09:53 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845644

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/30/2024
Section Cited
CCR
101200(a)(1)

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101200 Inspection Authority of the Department (a) The Department has the inspection authority specified in Health and Safety Code Sections 1596.852, 1596.853 and 1596.8535. (1)...
This regulation was not met as evidenced by:
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The licensee agrees to comply with the Title 22 regulations of Inspection Authority, by allowing the department representatives to conduct mandated inspections. The licensee also agrees to submit a written understanding of the regulation and submit a plan to
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Based on LPAs Interviews and observations, a licensee representative D. Keeler, refused the assigned LPA Susan Brewer, inspection authority on 10/29/2024, as directed by Owner Hanbo Liang and Director Karen Brazzill, which is an immediate risk to the health and safey of children in care.
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department on or before 10/30/2024, and contact the department to arrange a meeting with department representatives to discuss the regulation and implentation of a plan to ensure future compliance in regard to inspection authority.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2024


LIC809 (FAS) - (06/04)
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