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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197420025
Report Date: 03/11/2020
Date Signed: 03/11/2020 09:26:50 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 HEAD START- BERTRANDFACILITY NUMBER:
197420025
ADMINISTRATOR:TEREZA ANJANFACILITY TYPE:
850
ADDRESS:7021 BERTRAND AVENUETELEPHONE:
(818) 342-2042
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:20CENSUS: 15DATE:
03/11/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Aunica DeFlacoTIME COMPLETED:
09:35 AM
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On 03/11/2020 at 8:35AM, Licensing Program Analyst (LPA) Karren Starks made an unannounced visit for the purpose of conducting a Case Management inspection for an incident that occurred on 02/27/20, reported on 02/28/20 with report being received on 03/05/20 LPA observed 15 children in care with 3 staff members.

Based on report received the facility was placed on lock down due to an incident that occurred on the elementary school site. The principal of the elementary school placed the school site on lock down due to an elementary school special needs student behaving in an aggressive manner, kicking classroom doors and throwing trash cans. The facility had 17 children in care at the time of the incident with 4 staff members present.

Based on interviews conducted, facility children were in the classroom at the time of occurrence. The classroom doors were locked, windows shut. Parents of the children in care were notified via telephone of the incident that lasted around 24 minutes by the Director.

No children in care were injured

Based on this information there was no violation of Title 22 Regulations.

No deficiency cited.

Copy of report and Notice of Site visit issued.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020
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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