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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411601
Report Date: 10/18/2022
Date Signed: 10/18/2022 04:25:28 PM


Document Has Been Signed on 10/18/2022 04:25 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/HAWTHORNE EARLY HEAD STARTFACILITY NUMBER:
197411601
ADMINISTRATOR:LENA BLAKENEYFACILITY TYPE:
830
ADDRESS:4951 W. 119TH PLACETELEPHONE:
(310) 675-0653
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:33CENSUS: 17DATE:
10/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Isabel VitelaTIME COMPLETED:
04:30 PM
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On 10/18/2022 Licensing Program Analyst (LPA) Doris Whitmore conducted an unannounced Case Management- Incident inspection for the purpose of following up on an Unusual Incident Report (UIR) submitted on 10/07/2022. LPA met with Isabel Vitela, Site Supervisor, who toured the LPA through the inside and outside of the facility. LPA observed 17 children in care and 6 staff. According to the UIR, on 10/7/2022 Staff 1( S1) during diaper change at 11:50a.m,. noticed that child rubbed his head and said ouch. Per the UIR Staff #1 begin to ask the child What happened?

During the investigation LPA interviewed Staff #1, Site Supervisor & Staff #2. LPA reviewed the sign in sheet the Scan Report ( Suspected Child Abuse and Neglect), Health Check, sign in sheets from October 3, 2022 to October 18, 2022. LPA reviewed child's file.

Per Title 22, Division 12, Chapter 3, California Code of Regulations, no deficiencies are cited. An exit interview was conducted. A copy of this report (LIC809) and Notice of Site Visit were provided to the Site Supervisor, Isabel Vitela
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
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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