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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020043
Report Date: 10/22/2021
Date Signed: 10/22/2021 03:14:47 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:HUDSON HEAD STARTFACILITY NUMBER:
198020043
ADMINISTRATOR:SANDRA CONRAD & KAREN SALIFACILITY TYPE:
850
ADDRESS:2335 WEBSTER AVETELEPHONE:
(562) 997-8000
CITY:LONG BEACHSTATE: CAZIP CODE:
90810
CAPACITY:30CENSUS: 14DATE:
10/22/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Sandra Conrad, Head TeacherTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection due to an incident that occurred on 09/30/21. LPA met with Sandra Conrad, Head Teacher, and Jenny Acosta, Program Administrator of Staff Services. Head Teacher guided LPA on a tour of the facility.
There were 14 children with 5 staff present upon arrival.

LPA conducted interviews and obtained documentation during this visit.

The incident that occurred on 09/30/21 was reported to the Department on 10/04/21, via telephone. The facility did not report the incident within the required 24 hours of occurrence.

Information reported to the Department indicated that Staff #4 and #2 may have violated Child #1's personal rights. In addition, the facility provided documentation to the department of the facility staff's awareness of the possible violation on or before 09/30/21.

LPA was not able to complete their investigation of the incident due to not enough information available at this time. Another visit on a different day or time will occur to reflect if there are any findings. However, due to the facility not reporting on time, the following deficiency listed on the attached deficiencies page is being cited in accordance with California Code of Regulations Title 22.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview was conducted with Sandra Conrad, Head Teacher, including, but not limited to Provider Rights, Appeal Procedures

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: HUDSON HEAD START
FACILITY NUMBER: 198020043
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/05/2021
Section Cited

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Reporting Requirements

(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.
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This requirement is not met as evidenced by the facility failing to report knowledge of the incident that occurred on 09/30/21 within the required time. This poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2021
LIC809 (FAS) - (06/04)
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