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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500256
Report Date: 03/10/2026
Date Signed: 03/10/2026 12:43:39 PM

Document Has Been Signed on 03/10/2026 12:43 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WILLIAMS HEAD STARTFACILITY NUMBER:
191500256
ADMINISTRATOR/
DIRECTOR:		ROSA GUERRAFACILITY TYPE:
850
ADDRESS:2444 N. DEL MAR AVE.TELEPHONE:
(626) 307-3400
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY: 196TOTAL ENROLLED CHILDREN: 179CENSUS: 145DATE:
03/10/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Patricia YaghnamTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Case Management Incident inspection at the above facility on 03/10/26 at 09:25 a.m. The purpose of this inspection is to follow up on an incident reported to the Department within 24 hours. At 09:40 a.m., LPA met with the facility representative who guided LPA on a tour of the facility and census was taken. According to the facility representative there are 179 children enrolled. Facility representative Laura Hernandez later arrived and assisted LPA with the rest of the inspection.

On 02/05/26 during outdoor play child 1 (C1) was climbing the apparatus when she missed a step and fell forward hitting her chin and mouth. C1 sustained a small cut on her bottom lip and had a bruise on the bottom gum. According to the incident report, C1 was bleeding from her mouth and bottom lip was swollen. C1 was brought indoors where staff assessed the injury, cleaned the area, provided an ice pack, and contacted the nurse. Parents of C1 were also notified of the injury and an ouch report was provided. Per staff, C1 was taken to the dentist to follow up on the injury.

LPA conducted an interview with staff 1 (S1) who stated that they were providing care and supervision in the sand area and observed when C1 fell while going up the stairs of the playground structure. According to S1, they were far away and observed C1 stand up with blood on their mouth. Per S1, S3 was the staff supervising the playground structure and observed the incident. S1 stated that S3 immediately assisted and assessed C1. Once S3 helped C1 stand up and observed blood the child was taken to the classroom where an icepack was provided. Interview conducted with S2 revealed that they were indoors when the incident occurred; however, they were called to assist C1. When S2 went to the playground they observed C1 was bleeding from their mouth.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS HEAD START
FACILITY NUMBER: 191500256
VISIT DATE: 03/10/2026
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Per S2, S3 stated that when C1 was going up the stairs on the playground structure the child fell possibly due to her foot getting stuck; however, it is unknown what caused C1 to fall. S2 stated that S3 was the staff supervising children using the playground structure and though they were present they couldn’t catch the child to prevent her from falling down. Once the child was brought into the classroom S2 cleaned the area and provided an ice pack. Per S2, they assessed C1 and observed that the child was bleeding from her teeth. S2 also stated that parents of C1 were notified as well as the manager. Once parents of C1 picked up the child they took her to the dentist for further observation of the injury. According to S2, the child returned the next day with some restrictions; however, there was no doctor note provided. Per S2, C1 couldn’t drink any fluids with a straw, and her food had to be chopped to ensure that the child was chewing with her back teeth. C1 did not lose any teeth due to the impact of the fall. LPA couldn’t interview S3 due to being on leave. LPA conducted an interview with C1 who attempted to explain how the injury occurred. C1 pointed to their mouth and teeth as the child attempted to explain that is where they hit themselves while on the playground structure. C1 also pointed to S2 when they were asked if they received any help from their teacher. According to the nurse, parents only verbally communicated the dentist restrictions and no note was provided.

During the inspection LPA toured the area where the incident took place and also took a picture of the playground structure and label. LPA observed that the label on the playground structure is age appropriate for the Early Head Start children; however, it does emphasize that while using the structure children should have sufficient strength and coordination as well as adult supervision is required. The play structure, materials, and equipment for children are in good condition and age appropriate. Currently the facility allows one child at a time when going up the stairs of the play structure and a teacher is there to support the child as well. LPA advised the facility representative that though the play structure is age appropriate staff should be observing children as they may not have sufficient strength and coordination while going up the stairs. Also, staff should assess the structure to ensure that there are no hazards to prevent any future incidents or accidents.

During this inspection, LPA interviewed Staff 1 (S1 thru 2) and Child 1 (C1).

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS HEAD START
FACILITY NUMBER: 191500256
VISIT DATE: 03/10/2026
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At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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, a civil penalty of $100 can be assessed.

An exit interview was conducted, and a copy of this report was provided to the facility representative Laura Hernandez.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
LIC809 (FAS) - (06/04)
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