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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570767
Report Date: 05/22/2023
Date Signed: 05/22/2023 12:10:11 PM

Document Has Been Signed on 05/22/2023 12:10 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
MONTEREY PARK S WEST, 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:
5622297934
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 38TOTAL ENROLLED CHILDREN: 30CENSUS: 26DATE:
05/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Cynthia SantosTIME COMPLETED:
12:20 PM
NARRATIVE
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The Licensing Program Analyst (LPA), T. Tran, made an unannounced visit at Kennedy Head Start to follow up a case management incident inspection that was self-reported by the facility to the Child Care Licensing Department on 5/16/23 regarding to the level of care and supervision. Upon arrival, LPA met with teacher, Kim Gaitan and toured the facility inside and outside. LPA observed proper care and supervision. About 10:05AM, Child Development Coordinator, Cynthia Santos arrived at the facility.

During today's visit, LPA completed staff and children files review. LPA obtained child and staff records. Interview was conducted with staff, children, and other. Based on the information that were gathered through interviews, on 5/16/23, there were 13 children with two staff. Approximately 10:00AM, class 01 was transitioning from outside to inside. Five minutes later, staff heard a knock on the door then found C1. Child was left outside at the enclosed play area for about 5 minutes without any adult direct supervision. S1 admitted that she failed to count the children when she took the last group of children inside. According to the available information, this incident was the result of a Title 22 violation for lack of care and supervision.

Per staff, by 5/26/23, Education Coordinator will conduct a training with center staff to review proper care and supervision during transition time. Then on 6/6/23, all staff will be scheduled to attend the training for care and supervision. A copy of the training agenda/materials and the list of attendees with their signatures submit to CCLD by 06/09/2023 as a plan of correction.

Type B deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Cynthia Santos.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2023
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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Document Has Been Signed on 05/22/2023 12:10 PM - It Cannot Be Edited


Created By: Tiffanie Tran On 05/22/2023 at 11:52 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KENNEDY HEAD START
FACILITY NUMBER: 191570767

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2023
Section Cited
CCR
101229(a)(1)

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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation. Staff failed to provide proper supervision while a child was left outside unsupervised.
This requirement is not met as evidenced by based on interviews staff failed to
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Facility agrees tol conduct a staff training to discuss proper care and supervision during transition time. The copy of the training agenda/materials and the list of attendee's with their signatures submit to CCLD by 06/09/2023 as a plan of correction.
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provide proper care and supervision for C1.
On 5/16/23, about 10:00AM, S1 admitted that she left C1 outside at the enclosed play yard area for about 5 minutes without any adult's supervision, which poses a potential health and safety risk to children in care.
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Possible informal meeting will be held at the RO office to discuss the level of care and supervision.

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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:Valarie Cook
LICENSING EVALUATOR NAME:Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023


LIC809 (FAS) - (06/04)
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