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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017771
Report Date: 01/18/2024
Date Signed: 01/18/2024 03:30:29 PM


Document Has Been Signed on 01/18/2024 03:30 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:HSA "PASITOS" HEAD START HEROS PRESCHOOL CENTERFACILITY NUMBER:
198017771
ADMINISTRATOR:ZAYRA RODRIGUEZFACILITY TYPE:
850
ADDRESS:9501 CALIFORNIA AVENUETELEPHONE:
(323) 513-0594
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:30CENSUS: 27DATE:
01/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Alicia NunezTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) T. Tran conducted an unannounced Case Management Incident visit at the above licensed facility to follow up on a self-reported incident occurred on 11/03/2023 involved a child in care. The Monterey Park Southwest Office received the writing report on 11/09/2023. LPA met with Site Supervisor, Alicia Nunez and we toured of the facility. LPA observed proper care and supervision.

LPA completed child and staff files review. LPA obtained child’s records, and personnel report. Interviews were conducted with staff, children, and other. On the day of the incident, there were 11 children with two teachers. Parent was notified of the incident. Based on the interviews conducted and the information that was gathered, C1 was never left alone and out of sights by the staff therefore, the above incident was not the result of a Title 22 violation for lack of care and supervision.

As of 11/06/23, all center staff had attended the training for care and supervision and zoning. LPA obtained the training documents and staff attendance for the record.

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, Alicia Nunez.

SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024
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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