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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191871630
Report Date: 06/11/2021
Date Signed: 06/11/2021 12:12:02 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LA MIRADA HEAD STARTFACILITY NUMBER:
191871630
ADMINISTRATOR:MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:5637 LA MIRADA AVE.TELEPHONE:
(323) 464-6982
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY:75CENSUS: 31DATE:
06/11/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Abigail Saucedo, Center ManagerTIME COMPLETED:
12:28 PM
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At 9:13a.m an unannounced in-person Case Management-Incident inspection was conducted by Licensing Program Analyst (LPA) Lissete Gonzalez to follow up on an Unusual Incident reported to facility staff on 5/29/21 (weekend). The incident was reported via telephone on 06/01/21 and via fax on 06/02/21 to Community Care Licensing.

Upon LPA's arrival to the building at 9:16a.m., LPA Gonzalez was greeted and let into the facility by Center Manager, Abigail Saucedo. LPA completed a COVID-19 assessment, sanitize her hands, signed in, and LPA's temperature was recorded; The purpose of the inspection was announced to the Center Manager.

Center Manager guided LPA on a tour of the facility to take census. There were 9 preschoolers with three staff in Room #03; 10 preschoolers with three staff in Room #04; and 12 preschoolers with two staff in Room #01. At 9:37a.m., photographs of the Preschool classroom including the restroom were taken. LPA observed facility to be following social distancing guidelines.

The Unusual Incident reported concerns of a possible violation of the Personal Rights of a Preschool child.

During today's inspection, between 9:59a.m.-11:37a.m., interviews were conducted with three staff and other witnesses in the Teacher's office. At 11:40a.m., file review of Child #1. Staff #3’s file is stored at the main office and was not available for review. LPA obtained a copy of sign in/out sheets for the week of May 24, attendance records for Child #1, the Child Care Facility Roster for Classroom #3, and other documentation.



Due to insufficient information available at this time, the above allegation needs further investigation.

Exit interview conducted with Center Manager, Abigail Saucedo. Appeal Rights explained and provided. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
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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