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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018814
Report Date: 01/15/2020
Date Signed: 01/15/2020 11:59:43 AM

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:SOTO HEAD START PRESCHOOLFACILITY NUMBER:
198018814
ADMINISTRATOR:MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:2616 E. 7TH ST.TELEPHONE:
(626) 572-5107
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY:60CENSUS: 23DATE:
01/15/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Child Dev. SupervisorTIME COMPLETED:
11:45 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), Tiffanie Tran conducted a Case Management inspection at the above facility to follow up on the self-reported incident that occurred on 6/18/2019. The Monterey Park South West Child Care Regional Office received the incident report on 6/18/2019.

LPA conducted files review and obtained child's document. Based on the information that were available center staff stated, C1 was playing in the library area, he lost his balance then hit his mouth on the book stand. No other children were involved. Parent was contacted. Child was taken to the dentist and no signs of damage to the gum. Child returned to school the next day with no restriction.
At this time based on the available information it does not appear this incident was the result of a Title 22 violation.

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: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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