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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419005
Report Date: 02/14/2020
Date Signed: 02/14/2020 12:48:58 PM

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:CII/SOUTH VERMONT HEAD STARTFACILITY NUMBER:
197419005
ADMINISTRATOR:TELMA CEAFACILITY TYPE:
850
ADDRESS:9022 S. VERMONTTELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:55CENSUS: 24DATE:
02/14/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Telma CeaTIME COMPLETED:
01:00 PM
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On 02/14/2020, Licensing Program Analyst (LPA ) Karren Starks made an unannounced visit for an incident that occurred on 01/14/2020 and reported on 01/15/2020 Per the report C1 was running, tripped and bumped his forehead on a cot.

LPA met with the Site Supervisor, Telma Cea and observed 24 children in care (10 Toddlers and 14 P/S). Proper teacher/child ratios observed.

Per interviews conducted and information obtained, during lunch time, Child 1 did not wish to eat and at this time Staff was placing the cots down for nap time. Child 1 began to run in the classroom, tripped, fell and bumped his forehead. There was no break in the skin, bruising was observed. Staff applied First Aid, supervision was present the entire time, with protocols being followed. No other children were injured or placed at risk during this time. Parent of C1 was contacted and the child was picked up from the program.

The child is no longer in this program due to aging out.
Based on this information there was no violation of Title 22 regulations. No deficiency cited. Copy of report and Notice of Site visit is being issued.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
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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