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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418048
Report Date: 01/26/2022
Date Signed: 01/26/2022 12:26:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CII/WESTERN HEAD START STATE PRESCHOOLFACILITY NUMBER:
197418048
ADMINISTRATOR:MARGARITA PARRAFACILITY TYPE:
850
ADDRESS:4277 S. WESTERN AVENUETELEPHONE:
(213) 252-4380
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:40CENSUS: 35DATE:
01/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Janice White, Site SupervisorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) T. Tran arrived at CII- Western Head Start to conduct an unannounced Case Management inspection that was self-reported on 11/09/2021 regarding child stated "teacher hit my hand in the restroom". The Monterey Park South West Child Care Regional Office received the incident report on 11/13/2021. About 10:20 AM, Site supervisor provided LPA a tour of the facility. LPA observed proper care and supervision.

LPA completed files review for staff, children, and obtained child's record. Based on the information that were gathered through interviews with staff and other. On the day of the incident, there were two staff supervised 12 children. According to the available information, it does not appear this incident was the result of a Title 22 violation for Personal Rights.

No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Janice White.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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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