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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018059
Report Date: 02/27/2025
Date Signed: 02/27/2025 02:35:21 PM

Document Has Been Signed on 02/27/2025 02:35 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:C11/NICKERSON GARDENS HEAD STARTFACILITY NUMBER:
198018059
ADMINISTRATOR/
DIRECTOR:		VANESSA DEVAUGHNFACILITY TYPE:
850
ADDRESS:11253 S. COMPTON AVE.TELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY: 32TOTAL ENROLLED CHILDREN: 27CENSUS: 23DATE:
02/27/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Janice WhiteTIME VISIT/
INSPECTION COMPLETED:
03:00 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
While conducting an investigation for a complaint, Licensing Program Analyst (LPA), T. Tran observed the following deficiency:

On 1/3/25, facility failed to report to licensing department regarding no running water during the operation for about 3 hours. During this situation, facility utilized emergency water sources to remain normal operation to ensure the health and safety of children and staff at the center.

LPA obtained the Unusual incident report for 1/3/25. POC was corrected during today's visit.

Facility was cited a type B deficiency. See Facility Evaluation Report LIC 809D for deficiency cited.

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, Janice White.
Denise GibbsTELEPHONE: (323) 981-3385
Tiffanie TranTELEPHONE: (323) 981-3350
DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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 2
Document Has Been Signed on 02/27/2025 02:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: C11/NICKERSON GARDENS HEAD START
FACILITY NUMBER: 198018059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2025
Section Cited
CCR
101212(d)

1
2
3
4
5
6
7
Reporting Requirement
This requirement is not met as evidenced by based on interview conducted facility failed to report the incident occurred on 1/3/25 which poses a potential health and safety risk to children in care.
1
2
3
4
5
6
7
LPA obtained the Unusual incident report for 1/3/25 for the record.
POC was corrected during today's visit.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Denise GibbsTELEPHONE: (323) 981-3385
Tiffanie TranTELEPHONE: (323) 981-3350

DATE: 02/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2025

LIC809 (FAS) - (06/04)
Page: 2 of 2