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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011311
Report Date: 03/03/2022
Date Signed: 03/03/2022 02:35:33 PM


Document Has Been Signed on 03/03/2022 02:35 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:WHITTIER HEAD STARTFACILITY NUMBER:
198011311
ADMINISTRATOR:LISA FIELDING & DEBORAH HOFACILITY TYPE:
850
ADDRESS:1761 WALNUT AVENUETELEPHONE:
(562) 591-9258
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:80CENSUS: 33DATE:
03/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Jenny Acosta & Natasha Jackson TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection on 03/03/22 due to an incident that was reported to the department. LPA met with Jenny Acosta, Program Administrator of Staff Services, and Natasha Jackson, Early Learning Center Manager. LPA singularly toured the facility prior to meeting with Jenny Acosta and Natasha Jackson. There were 33 children and 8 staff present upon arrival.

LPA conducted interviews and obtained documentation during this visit.

The incident that was reported to the department occurred on 03/02/22. The incident was reported to the Department on 03/03/2022, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that Child #1 sustained an injury.

Based upon information received from the interviews conducted it was determined that Child #1 sustained the injury outside of the facility. Facility staff are mandated reporters and reported the incident to protective services. LPA advised that if there are any updates to the incident to contact the department.

There were no deficiencies cited during today’s.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview was conducted with Jenny Acosta, Program Administrator of Staff Services, and Early Learning Center Manager, Natasha Jackson, but not limited to Provider Rights, Appeal Procedures

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
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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