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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413312
Report Date: 09/21/2022
Date Signed: 09/21/2022 02:26:15 PM


Document Has Been Signed on 09/21/2022 02:26 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/CESAR CHAVEZ HEAD STARTFACILITY NUMBER:
197413312
ADMINISTRATOR:LA KISHA SEAY-WHITTIKERFACILITY TYPE:
850
ADDRESS:1269 NO. AVALON STREETTELEPHONE:
(310) 834-1839
CITY:WILMINGTONSTATE: CAZIP CODE:
90744
CAPACITY:34CENSUS: 24DATE:
09/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Vera FrescasTIME COMPLETED:
02:30 PM
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On 9/21/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted a Case Management- Incident inspection for the purpose of following up on the Unusual Incident Report (UIR) submitted on 05/5/2022. LPA met with Vera Frescas, Education Coordinator, and discussed the purpose of the visit. LPA observed 24 children with 5 staff.

According to the UIR, on 05/04/2022 at approximately 3:45pm, Child 1 (C1) lost her balance as she was playing with scarves and fell in the outdoor play area. Staff 1 (S1) helped child and applied ice on C1's arm. At approximately TIME, S1 observed C1 crying because her arm continued to hurt and S1 alerted the Education Coordinator who called Parent 1 (P1). P1 stated she would take C1 to the doctor. .

During the investigation, LPA conducted interviews with the Education Coordinator and Staff 2. LPA toured the inside of the classroom, and reviewed C1's file including the Family Progress and Contact Notes, excused absence note from C1's doctor, the facility's internal Child Incident Report.

At this time further investigation is needed.

An exit interview was conducted and a copy of this report along with the Notice of Site Visit were provided to Vera Frescas, Education Coordinator.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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