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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500256
Report Date: 03/03/2022
Date Signed: 03/03/2022 02:26:14 PM


Document Has Been Signed on 03/03/2022 02:26 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:WILLIAMS HEAD STARTFACILITY NUMBER:
191500256
ADMINISTRATOR:ROSA GUERRAFACILITY TYPE:
850
ADDRESS:2444 N. DEL MAR AVE.TELEPHONE:
(626) 307-3400
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:188CENSUS: 60DATE:
03/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Venneka Powell-Shannon - Early Care and Learning Program ManagerTIME COMPLETED:
02:40 PM
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At 11:55AM an unannounced Case Management-Incident inspection was conducted by Licensing Program Analysts (LPAs) Lissete Gonzalez and Carolyn Tuba to follow up on an Unusual Incident. The incident was self-reported via telephone on 02/15/2022 and via email on 02/22/2022 to Community Care Licensing. Upon arrival, LPAs met with Early Care and Learning Program Manager, Venneka Powell-Shannon. The purpose of the inspection was announced.

The facility reported to the Department that the incident occurred on 2/14/2022. The incident was reported to the Department timely. Early Care and Learning Program Manager, Venneka Powell-Shannon guided LPAs on a tour of the facility. Census was taken. The Unusual Incident reported concerns of a possible violation of the Personal Rights of Child #1 from Room #1 by a Staff member. Child #1 was unable to identify the staff member.

During today's inspection, LPA obtained documentation including the children’s roster and interviews were conducted with staff and witnesses. There were no disclosures to corroborate the allegation. This agency has investigated the allegation of a personal rights violation. Based the information obtained and interviews conducted, no follow-up is necessary regarding the incident. There is not a preponderance of evidence to prove the alleged violation did or did not occur.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Early Care and Learning Program Manager, Venneka Powell-Shannon.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
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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