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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418048
Report Date: 09/07/2022
Date Signed: 09/07/2022 10:36:30 AM


Document Has Been Signed on 09/07/2022 10:36 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, 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: 24DATE:
09/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Daniela TroyaTIME COMPLETED:
10:45 AM
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About 9:00AM, Licensing Program Analyst (LPA) T. Tran arrived at 4277 Western Ave. Los Angeles CA 90062 to conduct a case management visit for capacity decrease in preschool program and capacity increase for the toddler option. Upon entering the facility, LPA observed the consolidated Covid-19 CHHS postings.
LPA met with Janice White, Site Supervisor, Daniela Troya, Director, and Pamela Beniez, Compliance Program Analyst and toured the facility.

The facility currently serves 40 preschoolers and 8 toddlers with infant license (198400300) on the premises. Facility requested a license capacity decrease for preschool program to 16 children and capacity increase 16 toddlers for the total capacity of 32 children. The hours of operation are 8:00 AM – 4:30 PM. The Fire clearance was obtained for the capacity decrease. The facility had sufficient indoor, outdoor space with toilets, changing table, and sinks to accommodate the 16 preschoolers and 16 toddlers.
LPA reviewed facility's sketch which matched the physical plant of the facility. LPA reviewed the facility's current/updated “Designation of Facility Responsibility” (LIC 308), current/updated “Administrative Organization (LIC309) and a current/updated Personnel record (LIC 500) and current (LIC 412) Monthly Operating Statement.

During this visit, LPA observed napping equipment was in good repair. Children’s belongings were stored separately. Isolation area met regulation requirement. Food preparation area was clean. Separate outdoor area/playground were cushioned and equipped with age appropriate structure/equipment and was free of hazardous material/debris. Drinking water available for children indoor and outdoor. Serviced fire extinguishers, smoke detectors/carbon monoxide detectors were observed.

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: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
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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