<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018057
Report Date: 09/08/2021
Date Signed: 09/08/2021 03:41:48 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:C11/ WATTS 1V HEAD STARTFACILITY NUMBER:
198018057
ADMINISTRATOR:PRISCILLA ALMEJOFACILITY TYPE:
850
ADDRESS:11230 SOUTH CENTRAL AVE.TELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:27CENSUS: 12DATE:
09/08/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Citlati Gudino, Site SupervisorTIME COMPLETED:
03:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) T. Tran arrived at CII-Watts IV Head Start to conduct a Case Management inspection that was self-reported on 09/01/2021 regards a child in care ran and fell, as a result, child sustained a minor head injury. The Monterey Park South West Child Care Regional Office received the incident report on 9/01/2021.

About 12:45 PM, LPA toured the facility indoor and outdoor. Files review were conducted, and child's document obtained. On the day of the incident, there were two staff supervised 5 children. Based on the information that were gathered during today's interviews, it does not appear this incident was the result of a Title 22 violation for lack of care and supervision. No deficiency was cited.

The content of this report was read and discussed in detail with the noted person.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1