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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500256
Report Date: 11/17/2021
Date Signed: 11/17/2021 01:10:09 PM

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:WILLIAMS HEAD STARTFACILITY NUMBER:
191500256
ADMINISTRATOR:ROSA GUERRAFACILITY TYPE:
850
ADDRESS:2444 N. DEL MAR AVE.TELEPHONE:
(626) 927-5722
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:156CENSUS: 88DATE:
11/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Venika Powell Shannon TIME COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Judy Mora conducted a Case Management inspection due to an incident that occurred on 11/12/21. LPA met with Venneka Powell Shannon, Early Learning Manager and Sandra Trani, Education Program Manager. LPA conducted interviews during this visit.

The incident that occurred on Friday, November 12, 2021 was reported to the Department on Monday, November 15, 2021. The facility reported the incident in a timely manner.

Based on the information provided during this visit, a substitute teacher left her group of children unattended in the cafeteria during picture day without communicating to other staff. However, there was another staff present that took over the supervision of the children at the time. The children were never left without the supervision of a staff member. The substitute teacher will not be returning to the program.

Based on the information obtained on this date, and interviews conducted with teachers, no follow-up is necessary regarding the incident.

Education Program Manager was advised to review Title 22 Regulation Section 101229 Responsibility for Providing Care and Supervision with all staff including substitutes especially when special events are to occur.

There were no deficiencies cited during this inspection.

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

Exit interview was conducted with Sandra Trani. Appeal rights explained & provided.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
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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