198000225-3-22-2023-33-CC-CTUA-CQ6VB4-20230322161654

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198000225
Report Date: 03/22/2023
Date Signed: 03/22/2023 04:16:58 PM

Document Has Been Signed on 03/22/2023 04:16 PM - 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	BASSETT HEAD START/ERWIN		FACILITY NUMBER:	198000225
ADMINISTRATOR:	R. DUCOING/Y. OROZCO		FACILITY TYPE:	850
ADDRESS:	943 N. SUNKIST AVENUE		TELEPHONE:	(626) 931-3161
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91746
CAPACITY:	168	CENSUS: 21	DATE:	03/22/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Irma Fuentes		TIME COMPLETED:	04:30 PM

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On March 22, 2023, at 2:00 pm Licensing Program Analyst (LPA) Carolyn Tuba conducted a case management inspection due to an incident that was self-reported and submitted by the facility that occurred on 1/4/2023. A Covid-19 risk assessment was conducted prior to entering the facility. LPA met with Child Development Supervisor, Irma Fuentes who guided LPA on a tour to obtain the census of 21 children with 5 staff. LPA conducted interviews with Staff 1 (S1) and #2 (S2).

The incident was reported to the Department within the required 24 hours of occurrence. The incident consisted with a child alleging that they had been touched inappropriately. The facility conducted their own investigation, and their findings were unfounded. Child #1 (C1) was not available for interview, as he had already gone home for the day. LPA will be reaching out to Education Supervisor, Yolanda Orozco for additional documentation, as she was not available during the visit.

At this time the case management needs further investigation.

No citations have been issued at this time.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

An exit interview was conducted, and a copy of this report was provided to Child Development Supervisor, Irma Fuentes along with Appeal Rights.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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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