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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018059
Report Date: 12/12/2019
Date Signed: 12/12/2019 12:25:27 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/NICKERSON GARDENS HEAD STARTFACILITY NUMBER:
198018059
ADMINISTRATOR:MARGARITA PARRAFACILITY TYPE:
850
ADDRESS:11253 S. COMPTON AVE.TELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:68CENSUS: 33DATE:
12/12/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Site SupervisorTIME COMPLETED:
12:40 PM
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Licensing Program Analysts (LPAs) Tiffanie Tran and Roxana Lopez arrived at the above facility to conduct a Case Management Incident inspection to follow up on the self-reported incident that occurred at CII- Nickerson Gardens on 11/22/19. The facility made the 24 hours self-report on 11/22/19. The Monterey Park SW Regional Office received the writing incident report on 11/25/19. Upon arrival, LPAs observed proper care and supervision. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.
LPAs completed child and staff’s records review. LPAs obtained child's document, personnel report, and care and supervision training agenda and materials.

Based on interviews conducted, it revealed that on the day of the accident there were four teachers with 15 children. About 12:00 p.m., during transition from lunch time to nap time, center staff in the food preparation area observed C1 was left in the children's restroom after another staff member assisted children from using the restroom. Children's restroom located in front of the food preparation area between Head Start class 01 and class 02. C1 was never out of sight by the center staff member. C1 did not show any signs of discomfort. 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. However, to protect the safety of the children in care and prevent future similar incident from reoccurrence, facility had taken action toward involved staff and provided care and supervision training to all staff member. In addition, management team has increase monitoring toward teaching staffs.

No deficiency was found. The content of this report was read and discussed in detail at the time of with the noted contact 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: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
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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