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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570767
Report Date: 01/21/2020
Date Signed: 01/21/2020 02:34:28 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:KENNEDY HEAD STARTFACILITY NUMBER:
191570767
ADMINISTRATOR:KIM GAITANFACILITY TYPE:
850
ADDRESS:17500 SOUTH BELSHIRETELEPHONE:
(562) 229-7934
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY:20CENSUS: 15DATE:
01/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:TeacherTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analysts (LPA's), Tiffanie Tran and Mayra Rivera conducted a Case Management incident inspection at the above facility to follow up on the self-reported incident that occurred on 10/9/2019. The Monterey Park South West Child Care Regional Office received the incident report on 10/11/19.

LPA's completed record review and interviews were conducted. Based on the information that was available
S1 stated due to substitute running late on 10/09/19, therefore was left alone supervising 15 children for about 20-25 minutes. S1 disclosed there were a few parents were present during the time of the incident occur.

At this time based on the available information it does appear this incident was the result of a Title 22 violation for operating out of ratio which poses an immediate health and safety risk to children in care.

LPAs obtained the declaration statement from staff. Type A deficiency was cited. Appeal Rights was provided. POC was corrected during today's inspection. The content of this report was read and discussed in detail at the time of with the noted contact person. LPAs discussed AB633 and informed the center director that, upon receipt of a Type A deficiency, the facility shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KENNEDY HEAD START
FACILITY NUMBER: 191570767
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/21/2020
Section Cited

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Teacher-Child Ratio
This requirement is not met as evidenced by based on record review facility failed to operate within ratio on 10/9/19 at 8:00 am S1 was left alone surpervising 15 children for about 20-25 minutes which poses an immediate health and safety risk to children in care.

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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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/21/2020
LIC809 (FAS) - (06/04)
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