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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018059
Report Date: 11/09/2023
Date Signed: 11/09/2023 11:32:54 AM


Document Has Been Signed on 11/09/2023 11:32 AM - 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:VANESSA DEVAUGHNFACILITY TYPE:
850
ADDRESS:11253 S. COMPTON AVE.TELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:32CENSUS: 25DATE:
11/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Janice WhiteTIME COMPLETED:
11:50 AM
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 Nickerson Garden Head Start to conduct an unannounced Case Management Incident that was self-reported on 11/01/2023 regarding a personal right concern. The Monterey Park Southwest Child Care Regional Office received the incident report on 11/01/2023. Upon arrival, LPA met with Site Supervisor, Janice White and we toured the facility. LPA observed proper care and supervision.

LPA completed files review for staff, children, and obtained LIC 500, child's record, and attendance sheet. Based on the information that were gathered through interviews with staff and other. On the day of the incident, there were two staff supervised 7 children. According to the available information, none of the interview staff had any concerns with a child's personal rights was violated at this center. Therefore, this incident was the result of a Title 22 violation for 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, Janice White.

SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023
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