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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002482
Report Date: 04/05/2022
Date Signed: 04/05/2022 03:23:04 PM


Document Has Been Signed on 04/05/2022 03:23 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:MAOF HEAD START ZOE AVENUE CENTERFACILITY NUMBER:
198002482
ADMINISTRATOR:CYNTHIA RODRIGUEZFACILITY TYPE:
850
ADDRESS:2650 ZOE AVE.TELEPHONE:
3235845828
CITY:HUNTINGTON PARKSTATE: CAZIP CODE:
90255
CAPACITY:85CENSUS: DATE:
04/05/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Monica A. Tello, Associate DirectorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) T. Tran made an unannounced visit at Zoe Head Start to complete a Case Management inspection that was self-reported on 11/12/2021 and 12/13/2021 regarding children with food allergy. Upon arrival, LPA met with Associate Director, Monica A. Tello.

LPA reviewed and obtained the following documents; December Professional Development Schedule, Attendance sheet of the training meeting conducted on 11/18/21, Updated Nutrition plan and policies, & Internal emails communication regarding nutrition plan.

Based on records reviewed and interviews were conducted, the facility had a written nutrition care plan was properly developed and trained to all teaching staff and staffs failed to properly implemented the daily best practices .An internal reviewed was addressed with teaching staff to ensure no future incidents from reoccurrence. Based on the available information, it does not appear these incidents were the result of a Title 22 violation for personal rights.

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, Monica A. Tello.




SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2022
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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