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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018033
Report Date: 01/26/2022
Date Signed: 01/26/2022 03:43:43 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MAOF HEAD START - LINDSAYFACILITY NUMBER:
198018033
ADMINISTRATOR:YOLANDA VELAFACILITY TYPE:
850
ADDRESS:1584 E.MARTINLUTHERKING JR.BLVTELEPHONE:
(323) 233-2839
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY:40CENSUS: 9DATE:
01/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Begly Munoz, Head TeacherTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) T. Tran arrived at MAOF Lindsay Head Start to conduct a Case Management inspection that was self-reported on 11/15/2021 regards a child in care fell from the chair and hit the head. The Monterey Park South West Child Care Regional Office received the incident report on 11/16/2021.

LPA toured the facility indoor and outdoor. Files review were conducted, and document were obtained. On the day of the incident, there were two staff supervised 13 children. Based on the information that were gathered during today's interviews, this incident occurred right after snack time. Staff observed child was swaying from the chair then child fell and hit the head. Staff immediately assisted child and observed no visible marks on child's face. Parent was informed upon pick up. Per parent, the next day, child was taken to the doctor, no loss of consciousness. Child missed one day of school and returned without any restrictions.

At this time based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.
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, Begly Munoz

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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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