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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017201
Report Date: 01/23/2023
Date Signed: 01/23/2023 04:12:03 PM


Document Has Been Signed on 01/23/2023 04:12 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:VOLUNTEERS OF AMERICA OF LOS ANGELESFACILITY NUMBER:
198017201
ADMINISTRATOR:MAYRA COTAFACILITY TYPE:
850
ADDRESS:15509 PARAMOUNT BOULEVARDTELEPHONE:
(310) 933-0685
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY:50CENSUS: 0DATE:
01/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Michelle HarrisTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) T. Tran conducted an unannounced Case Management Incident visit at VOA Head Start to follow up self-reported incident occurred on 09/28/2022 involved a child in care fell and paramedics required. The Monterey Park South West Office received the writing report on 09/30/2022. LPA met with Michelle Harris, Education Coordinator. LPA observed proper care and supervision.

LPA completed child and staff’s files review. LPA obtained child's document, children's and personnel report.
Interviews were conducted with staff and other. On the day of the incident, there were 11 children with two teachers. Parent was notified of the incident. 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.

No deficiency was cited at this time. 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, Michelle Harris.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
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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