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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017704
Report Date: 05/23/2022
Date Signed: 05/23/2022 12:19:20 PM


Document Has Been Signed on 05/23/2022 12:19 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:CESAR CHAVEZ HEAD STARTFACILITY NUMBER:
198017704
ADMINISTRATOR:DOLORES TREVINO & JULIE SAFACILITY TYPE:
850
ADDRESS:730 W. 3RD STREET AVENUETELEPHONE:
(562) 491-7536
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY:60CENSUS: 15DATE:
05/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Jenny Acosta, Program AdministratorTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection due to an incident that occurred on 05/16/22. LPA met with Dolores Trevino, Head Teacher, who guided LPA on a tour of the facility. There were 15 children and 5 staff present upon arrival. LPA was later met by Blanca Litzinger, Early Learning Center Manager, and Jenny Acosta, Program Administrator.

The purpose of the visit was to follow-up on an incident that was reported to the department.

LPA conducted interviews and obtained documentation during this visit.

The incident that occurred on 05/16/22, was reported to the Department on 05/16/22, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that Staff #1 had to administer First-Aid/CPR to Child #1. Staff #1 is First-Aid/CPR certified.

Based upon information received from the interviews conducted it was determined that there was no violation of Title 22.

There were no deficiencies cited during today’s inspection. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview was conducted with Jenny Acosta, Program Administrator, including, but not limited to Provider Rights, Appeal Procedures.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
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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