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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417861
Report Date: 03/05/2020
Date Signed: 03/05/2020 10:56:26 AM

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:CCRC TULSA HEAD STARTFACILITY NUMBER:
197417861
ADMINISTRATOR:TEREZA YEDUYANFACILITY TYPE:
850
ADDRESS:10900 HAYVENHURST AVE.TELEPHONE:
(818) 717-4515
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:34CENSUS: 25DATE:
03/05/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Tereza Yeduyan DirectorTIME COMPLETED:
11:10 AM
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On 3/5/ 2020 licensing Program Analyst (LPA), Jeanette Estrada conducted an unannounced case- management visit to follow up on the incident report that was submitted to the department on 2/21/2020. The report indicated that on 2/13/2020 Child #1 was upset, climbed on a shelf and kicked the window causing it to brake. In the report it is stated that no other children were present when the incident took place and no one was injured.

LPA observed that the area where the broken window is has been covered. There has been a large wooden panel screwed on to the window sill. The window will be replaced at a later time. LPA observed no hazards surrounding the broken window area.

From interviews conducted with the Director and Staff #1, it is determined that the facility took appropriate actions when the incident took place and there is a plan in place in case another similar incident occurs.

At this time no deficiencies are being cited. An exit interview was conducted and a copy of this report along with the Notice of Site Visit were given to the facility representative.

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3023
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
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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