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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191871630
Report Date: 06/15/2022
Date Signed: 06/15/2022 03:23:07 PM


Document Has Been Signed on 06/15/2022 03:23 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
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: 49DATE:
06/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:54 PM
MET WITH:Abigail Saucedo, Center ManagerTIME COMPLETED:
03:37 PM
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On 6/15/2022, Licensing Program Analysts (LPA) Lissete Gonzalez and Veronica Martinez-Garza conducted a Case Management inspection due to an incident that was reported to the facility on 05/29/2021. Upon arrival, LPA’s met with Center Manager, Abigail Saucedo. This is a subsequent inspection to the initial inspection conducted on 06/11/2021. Census was taken.

The incident was reported to the Department via telephone on 06/01/2021 and via fax on 06/02/2021 to Community Care Licensing. The facility reported the incident to the Department in a timely manner. The Unusual Incident, which was reported, was an allegation of a possible violation of the Personal Rights of a child.

The unusual incident reported that child #1 (C1) disclosed to their authorized representative that staff #1 (S1) touched C1 inappropriately. LPA L. Gonzalez conducted interviews with witnesses and obtained documentation including the facility roster. A copy of the law enforcement report was obtained with no finding. LPA continued to request updated police records through 6/2021-5/2022 however, LPA was unable to obtain additional reports at the time of this visit. S1 was terminated from the facility immediately after the incident was reported. In addition, there were no corroborating statements or evidence to support the allegation. Based on the information obtained and interviews conducted, there is not a preponderance of evidence to prove the alleged violation did or did not occur. At this time, there are no deficiencies being cited in regard to this incident.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Abigail Saucedo.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2022
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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