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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015579
Report Date: 10/20/2020
Date Signed: 10/20/2020 09:59:24 AM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:VOALA AZTECA HEAD START, BUILDING BFACILITY NUMBER:
198015579
ADMINISTRATOR:EDIE SMITHFACILITY TYPE:
850
ADDRESS:518 N. DANGLER AVENUETELEPHONE:
(323) 780-3770
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY:39CENSUS: 14DATE:
10/20/2020
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:03 AM
MET WITH:Roselia Recendez, Site SupervisorTIME COMPLETED:
10:15 AM
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At 8:03a.m., on October 20, 2020, an unannounced Case Management visit was conducted by Licensing Program Analysts (LPAs) Lissete Gonzalez and Nolan Tcheng to provide the following letter:
  • ORDER TO INDIVIDUAL OF IMMEDIATE EXCLUSION FROM ALL FACILITIES: VIDA VAZQUEZ

Upon arrival, LPAs met with Site Supervisor, Roselia Recendez.

LPA Gonzalez advised Site Supervisor, Roselia Recendez, that Vida Vazquez is excluded from VOALA Azteca Head Start effective 10/15/2020 and any other licensed facilities by the Department of Social Services. Site Supervisor & Vida Vazquez have 15 days to submit an appeal. The address for the appeal was provided and the Site Supervisor was advised of the appeal process for this Order to Individual of Immediate Exclusion from All Facilities.

Exit interview conducted with Site Supervisor, Roselia Recendez. Appeal Rights (LIS 9058) explained and a copy was provided.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
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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