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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197400791
Report Date: 02/15/2023
Date Signed: 02/15/2023 03:30:08 PM


Document Has Been Signed on 02/15/2023 03:30 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:VOA/EARLY HEAD STARTFACILITY NUMBER:
197400791
ADMINISTRATOR:FELIX CRUZFACILITY TYPE:
830
ADDRESS:11243 KITTRIDGETELEPHONE:
(818) 980-2287
CITY:NO. HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:20CENSUS: 3DATE:
02/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:39 PM
MET WITH:Edith SmithTIME COMPLETED:
03:30 PM
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On 02/15/2023 Licensing Program Analyst ( LPA) Doris Whitmore follow up on an UIR that was received in the office. on 01/30/2023. At the time that LPA visited the classroom was only three children and LPA reviewed documentation Suspected Child Abuse Report (SS8572) and report.LPA Whitmore spoke with Edie Smith Area Manager that the Department of Social Services was contacted and a report number was given to them. After the incident staff has noticed that the child is coming school with the appropriate clothing and the hygiene concern has disappeared. The rash was in between the fingers and on the thigh has cleared up. LPA reviewed child's file and saw pictures that was taken of the area of the rash. Also Area Manager Edie Smith stated that the child does not have any more lice in his hair. Child was present at the time of the visit. There were no deficiencies on 02/15/2023. Acopy of report and Notice of Site Visit along with appeal rights was given to Edie Smith.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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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