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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597736
Report Date: 09/14/2023
Date Signed: 09/14/2023 03:27:53 PM


Document Has Been Signed on 09/14/2023 03:27 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CARVER HEAD START/STATE PRESCHOOLFACILITY NUMBER:
191597736
ADMINISTRATOR:ROSELIA GOMEZFACILITY TYPE:
850
ADDRESS:19200 ELY STREETTELEPHONE:
(562) 229-7933
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:38CENSUS: 23DATE:
09/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Silvia TroncosoTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) T. Tran arrived at Carver Head Start to conduct a Case Management inspection that was self-reported on 09/07/2023 pertaining to care and supervision. The Monterey Park South West Child Care Regional Office received the incident report on 9/08/2023. Upon arrival, LPA met with Silvia Troncoso, Education Coordinator and observed children were napping. LPA toured the facility, proper care and supervision observed.

Child and staff files review were conducted. LPA obtained facility daily schedules, personnel report, and child's document. Interviews were conducted with staff, children, and other. On the day of the incident, there were two staff supervised 5 children. Based on the information that were gathered during today's interviews, it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

No 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, Silvia Troncoso.

SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023
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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