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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001331
Report Date: 06/11/2021
Date Signed: 06/11/2021 03:49:13 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:MAOF HEAD START SANTA FE CENTERFACILITY NUMBER:
198001331
ADMINISTRATOR:MARIA HIGAREDAFACILITY TYPE:
850
ADDRESS:6812 SANTA FETELEPHONE:
(323) 581-3923
CITY:HUNTINGTON PARKSTATE: CAZIP CODE:
90255
CAPACITY:36CENSUS: 16DATE:
06/11/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Maria Alvarez, Head TeacherTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) T. Tran arrived at MAOF Head Start Sante Fe Center to conduct a Case Management inspection that was self-reported on 06/02/2021 regarding a child fell and required medical attention. The Monterey Park South West Child Care Regional Office received the incident report on 6/04/2021.

LPA conducted staff and child's file review, and document were obtained. On the day of the incident, there were 3 staff supervised 12 children. Based on the information that were gathered through today's interviews, during morning outdoor play, C1 was running with a hula hoop, then tripped, fell on the left arm. Child sustained a occult elbow fracture. Child is required to wear a cast for 3 weeks. Child missed one day of school. No other children were involved. Parent was contacted.

At this time based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision. No deficiency was cited.

The content of this report was read and discussed in detail with the noted person.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt


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

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
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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