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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017626
Report Date: 05/04/2023
Date Signed: 05/04/2023 11:36:52 AM


Document Has Been Signed on 05/04/2023 11:36 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CII/MAIN STREET HEAD STARTFACILITY NUMBER:
198017626
ADMINISTRATOR:MELISA MORGANFACILITY TYPE:
850
ADDRESS:9505 SOUTH MAIN STREETTELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY:90CENSUS: 49DATE:
05/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Griselda Callejas, TIME COMPLETED:
11:55 PM
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Licensing Program Analyst (LPA) T. Tran arrived at CII Main Street Head Start to conduct a Case Management inspection that was self-reported on 03/17/2023 regards to a child got injured in the mouth causing a tooth to chip during outdoor play. Upon arrival, LPA met with ECS Manager, Griselda Callejas and toured the center. LPA observed proper care and supervision and ratio.

LPA completed files review for staff and children. LPA obtained LIC500 personnel report and child's document. Interviews were conducted with staff, children, and other. According to the information that were gathered through the interviews, on 3/17/23, there were 4 children in attendance with a fully qualified teacher. When the incident occurred, S1 immediately attended and provided proper care for C1. Parent was also contacted in a timely manner. 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, Griselda Callejas.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023
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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