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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017652
Report Date: 05/09/2019
Date Signed: 05/09/2019 01:29:15 PM

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:OPTIONS HEAD START VILLA PARKEFACILITY NUMBER:
198017652
ADMINISTRATOR:DENISE FERNANDEZFACILITY TYPE:
850
ADDRESS:363 EAST VILLA STREETTELEPHONE:
(626) 844-0418
CITY:PASADENASTATE: CAZIP CODE:
91101
CAPACITY:38CENSUS: 17DATE:
05/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Angelica AlatresteTIME COMPLETED:
01:28 PM
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Ana Chico, Licensing Program Analyst (LPA) conducted an unannounced Case Management Inspection. LPA met with Angelica Alatriste, Designee. Diana Catellanos, Education Coordinator was also present.

The purpose for this visit is to follow up on an incident reported to the Department via phone call on 2/22/19. The Unusual Incident/ Injury Report was reported as required by the licensee. During the course of the inspection, LPA toured the area where child received injury and interviewed supervising staff who observed the incident.

According to Staff #1 she was directly supervising a group of children walking across a garden border wall when child #1 lost his balance and hit the back of his head. There were three staff supervising the playground. Child immediately received first aid and parent was called. Parent arrived and took child to seek medical attention. Child returned to school the following day.
Per Staff #1, as a preventive measure, teachers have positioned themselves at the end of the border wall when children are playing. At this time no deficiencies are being cited as the incident was deemed an accident.

No Deficiencies Cited

Exit interview conducted. Notice of Site Visit must be posted for (30) days.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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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