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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413312
Report Date: 12/14/2022
Date Signed: 12/14/2022 11:49:48 AM


Document Has Been Signed on 12/14/2022 11:49 AM - 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: 22DATE:
12/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Vera FrescasTIME COMPLETED:
11:48 AM
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On 12/14/2022 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 11/01/2022. LPA met with Vera Frescas Education Coordinator, who toured the LPA inside and outside of the facility. LPA observed 22 children in care and 4 Staff. According to the UIR on 11/01/2022 Child was running and bumped into another child and fell. Staff #2 observed the child running. Parent was given an ouch report and took child to the doctor. Documentation from the doctor was provided.

During the investigation LPA interviewed Staff#1 Education Coordinator & Staff #2. LPA reviewed and obtained copies of Sign in Sheets for the month of October, November, & December, Doctor's Note, Ouch Report. Based on the information gathered The facility has taken all necessary steps there are no deficiencies or citations . An exit interview was conducted. A copy of this report (LIC 809) and Notice of Site Visit were provided to the Education Coordinator, Vera Frescas
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022
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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