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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015104
Report Date: 01/29/2020
Date Signed: 01/29/2020 02:03:47 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:PARK PLACE HEAD STARTFACILITY NUMBER:
198015104
ADMINISTRATOR:MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:2630 EAST 7TH STREETTELEPHONE:
(323) 780-3232
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY:40CENSUS: 27DATE:
01/29/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Center ManagerTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPAs) Tiffanie Tran and Nolan Tcheng arrived at the above facility to conduct a Case Management inspection on a self-reported incident that occurred on 05/08/2019. The Monterey Park South West Child Care Regional Office received the incident report on 08/12/2019.

LPAs obtained child's and other document. Based on the information that were available about 9:25 a.m. while children were lining up to go outside, center staff observed C1 been pushed by a peer standing behind. Child fell hit the back of the ear on the sink. C1 sustained a cut behind the ear.
Parent was contacted. Child was taken to the doctor for medical care. C1 returned to school with no restriction. 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.

The content of this report was read and discussed in detail at the time of with the noted contact 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: 07/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019
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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