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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 03:47:07 PM


Document Has Been Signed on 05/04/2023 03:47 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
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: 0DATE:
05/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Griselda CallejasTIME COMPLETED:
04:00 PM
NARRATIVE
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The Licensing Program Analyst (LPA), T. Tran, conduct an unannounced site visit at CII- Main Street HS to follow up on a Case Management Incident occurred on April 27, 2023. LPA met with Griselda Callejas, ECS Manager and toured the facility inside and outside. LPA observed children were dismissed around 12:00PM. Per staff, children had early dismissal week to observe Teacher's Appreciation Day.

LPA reviewed children and staff files. LIC500 Personnel Report and child's document was obtained during today's visit. LPA conducted interviews with staff, child, and other.

On 4/7/23 there were 8 children present with 2 teachers. While children were helping cleaning the table after breakfast. S1 observed C1 used the spray bottle that contained water for cleaning the table then sprayed it on another peer's face. After S1 explained to C1 the intended of spray bottle was to clean the table then S1 admitted of the wrongdoing by sprayed a little on C1's face to help C1 understand the action was inappropriate. Based on the facts presented and the information that was gathered through interviews, this incident was the result of Title 22 Personal Rights Violation.

Per facility representative, facility will conduct a training to all center staff on 5/8/23 regarding to topics of care and supervision and children personal rights. Then submit to the department training materials indicating the effective procedure of care and supervision and children's personal rights along with sign in sheet of all staff in attendance by 5/12/23.

Type B 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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Document Has Been Signed on 05/04/2023 03:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 START
FACILITY NUMBER: 198017626

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2023
Section Cited

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Personal Rights. Each child shall be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature.
This requirement is not met as evidenced by based on interview facility sstaff failed to protect a child's personal rights by
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Facility Representative agrees to submit to the department training materials indicating the effective procedure of care and supervision and children's personal rights along with sign in sheet of all staff in attendance on or before 5/12/23 in order to clear this citation.
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S1 admitted the action of wrongdoing by sprayed water bottle on C1's face to help child understand the inappropriate behavior which poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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