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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018057
Report Date: 10/24/2022
Date Signed: 10/24/2022 12:36:27 PM


Document Has Been Signed on 10/24/2022 12:36 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: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: 0DATE:
10/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tashionia HaywoodTIME COMPLETED:
12:45 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 conducted an unannounced Case Management Incident visit at CII Watts IV Head Start to follow up self-reported incident occurred on 08/30/2022 regarding a child’s personal rights. The Monterey Park South West Office received the writing report on 09/1/2022. LPA met with Tashionia Haywood and we toured the facility. LPA did not observe any children in care due to staff in service day.

LPA completed child and staff’s files review. LPA obtained child's document, children's and personnel report.
Interviews were conducted with staff and other. On the day of the incident, there were 8 children with three teachers. The facility had developed a comprehensive plan to support staff and child while in care. Parent was notified of the incident. Based on the available information it does not appear this incident was the result of a Title 22 violation for child’s personal rights.

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, Tashionia Haywood

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022
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