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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015106
Report Date: 05/10/2022
Date Signed: 05/10/2022 12:01:20 PM


Document Has Been Signed on 05/10/2022 12:01 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:EUCLID HEAD STARTFACILITY NUMBER:
198015106
ADMINISTRATOR:MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:817 S. EUCLID AVENUETELEPHONE:
(323) 264-9220
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY:30CENSUS: 27DATE:
05/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH: Dany Gutierrez, TeacherTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA), Tiffanie Tran conducted an unannounced case management visit for the purpose of inspecting the replacement of the playground structure. Upon arrival, LPA met with Dani Gutierrez and tour the outdoor area. About 11:50 AM, LPA observed site supervisor Samira Alvarez arrived at the facility.

LPA observed proper care and supervision. LPA observed the playground structure had been replaced with the wood playground structure. The equipment observed to be age appropriate and under high climbing equipment had cushioned with material that absorbs falls.

No deficiency was found during today’s visit. 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, Samira Alvarez, Site Supervisor

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022
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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