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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806026
Report Date: 11/17/2021
Date Signed: 11/17/2021 10:15:29 AM

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:GREGORY PARK HEAD START/STATE PRE SCHOOLFACILITY NUMBER:
191806026
ADMINISTRATOR:MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:5807 GREGORY AVE.TELEPHONE:
(323) 463-3061
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY:60CENSUS: 39DATE:
11/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria Nava TIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Judy Mora conducted a case management inspection due to an incident that occurred on 11/02/2020 (Incident #1) and 11/02/2021 (Incident #2). LPA met Center Manager Maria Nava, who guided LPA on a tour of the facility at approximately 09:15 AM.

LPA observed 12 children with 03 staff in Room 1, 10 children with 03 staff in Room 02, 08 children with 03 staff in Room 3 and 09 children with 03 staff in Room 4. LPA conducted interviews and obtained documentation during this visit.

The incident that occurred on 11/02/20 was reported to the Department on 11/03/20 and the incident which occurred on 11/02/21 was reported on 11/03/21. Both incidents were reported in a timely manner to the Department as required.

Incident #1: The child who was injured and the staff who observed the incident are no longer at the facility.
No follow up is needed at this time.

Incident #2: Based on the information obtained on this date, and interview conducted with the teacher who observed the incident, no follow-up is necessary. The incident appears to be an unusual accident. There was nothing the facility staff could have done to prevent the incident from occurring. LPA observed the outdoor play area to be safe and free of hazards. LPA obtained a copy of child's Emergency Card, doctor note from injury and a copy of the facility's individual care plan.

There were no deficiencies observed during today's inspection.

A Notice of Site Visit was given and must remain posted. Exit interview was conducted with Maria Nava. 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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