198015390-9-24-2021-54-CC-RRAS-C76TQJ-20210924145602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015390
Report Date: 09/24/2021
Date Signed: 09/24/2021 02:57:21 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:	SMITH HEAD START		FACILITY NUMBER:	198015390
ADMINISTRATOR:	ANGELA HULLETT & PETRINA D		FACILITY TYPE:	850
ADDRESS:	565 E. HILL STREET		TELEPHONE:	(562) 426-6313
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	80	CENSUS: 28	DATE:	09/24/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Angela Hulett & Shameeka Robinson Horn		TIME COMPLETED:	03:15 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection due to an incident that occurred on 09/07/2021. LPA met with Angela Hulett, teacher, upon arrival to the facility, who guided LPA on a tour of the facility. LPA was later met by Shameeka Robinson Horn, Early Learning Manager. There were 28 children and 8 staff present upon arrival.

LPA conducted interviews and obtained documentation during this visit.

The incident that occurred on 09/07/21, was reported to the Department on 09/08/21, 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 that required medical attention.

Based upon information received from the interviews conducted it was determined that Child #1 sustained an injury that was observed by staff, first-aid was administered, and parent was notified. LPA did advise facility representatives about record keeping during the inspection.

There were no deficiencies cited during today’s inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Shameeka Robinson Horn.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita Ramos	TELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 1