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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017626
Report Date: 02/14/2023
Date Signed: 02/14/2023 11:35:20 AM


Document Has Been Signed on 02/14/2023 11:35 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
CCLD Regional Office, 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:
2133855100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY:90CENSUS: 71DATE:
02/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Irma VillarrealTIME COMPLETED:
11:45 AM
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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 01/24/2023 regards to a personal rights concern of a child in care. Upon arrival, LPA met with Irma Villarreal and toured the center. LPA observed proper care and supervision and ratio.

Files review was conducted for child and staff. LPA obtained the children's roster and personnel report . LPA interviewed with staff, children, and other. The alleged classroom was fully enrolled with 15 children with two teachers. The interviewed staff and children did not observed S1 violated C1 Personal Rights. Based on the available information it does not appear this incident was the result of a Title 22 violation for Personal Rights.

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, Irma Villarreal.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
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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