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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018814
Report Date: 01/15/2020
Date Signed: 01/15/2020 03:47:43 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: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: 25DATE:
01/15/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Child Dev. SupervisorTIME COMPLETED:
04:10 PM
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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 10/10/2019. The Monterey Park South West Child Care Regional Office received the incident report on 10/10/2019.

LPA completed child and staff reviewed. LPA obtained personnel and child’s documentation.
Based on the available information that were gathered through interviews and record reviews, during outdoor play, staff observed C1 eyes were fluttering and gazing at the sky. Staff immediately shared with management team and consulted with child's parent. Parents took child to a neurologist. Doctor indicated child is sensitive to light which caused child to have a seizure. Medication was to child by parents at home.

Incidental Medical Services (IMS) were discussed and IIMS-PO obtained. The facility does provide IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel and administrative records.

At this time, no deficiencies were observed or cited in relation to this incident. 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)
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