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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500284
Report Date: 08/24/2022
Date Signed: 08/24/2022 10:14:44 AM

Document Has Been Signed on 08/24/2022 10:14 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WILLARD HEAD STARTFACILITY NUMBER:
191500284
ADMINISTRATOR:MICHELLE COLLASOFACILITY TYPE:
850
ADDRESS:3152 N. WILLARD AVE.TELEPHONE:
(626) 307-3379
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY: 18TOTAL ENROLLED CHILDREN: 17CENSUS: 11DATE:
08/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Millie Lim Wong TIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced Required 1 year inspection. LPA met with Lead Teacher, Millie Lim Wong. This is a preschool age program licensed for 18 children which operates Monday – Friday from 8:00 AM – 2:00 PM. The facility is located on the elementary school grounds of Williard Elementary School. Per Lead Teacher there are 17 children enrolled. Covid Precautionary Measures are being conducted at the main entrance of the facility. Education Manager, Venneka Powell-Shannon, arrived during this inspection.

At approximately 9:05 AM LPA Mora began self tour of the facility. This facility consists of one classroom. All areas identified on the facility sketch were inspected. LPA observed 11 children present with 02 staff in the classroom and preparing for transition to the outdoor yard. Teacher-child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. All staff is fingerprint cleared as a condition of employment through the Garvey School District. During this inspection, all children were observed to be under visual supervision of a teacher at all times.

LPA observed required forms to be posted on the Parent Board located near entrance of facility. LPA observed the following: Facility License, Snack Menus, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights, and LIC 610 Emergency Disaster Plan. LIC 9148 Earthquake Preparedness and Verification of Disaster and Fire Drills were reviewed, last drill was 05/2022.

LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. All surfaces and materials accessible to children, including toys, are toxic free. All toilets are in safe and sanitary operating conditions, however, LPA observed that the 3 sinks in the both preschool classrooms are not in good repair. The edges around the sinks are noticeably lifting and very rusted. All classroom floors were observed to be safe and clean.

REPORT CONTINUES ON NEXT PAGE*
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2022
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 3
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLARD HEAD START
FACILITY NUMBER: 191500284
VISIT DATE: 08/24/2022
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At this time, the library area is used as an isolation area. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted. Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides breakfast, lunch and PM snack. All food items come from the elementary school kitchen. LPA observed a water machine and disposable cups available for drinking water outdoors and a water pitcher and disposable cups inside the classroom. All containers used for storage of solid wastes have a tight fitting cover on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Storage areas for poisons are locked. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

The outdoor playground is fully fenced. Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. LPA observed age appropriate toys and equipment. The areas around and under high climbing equipment and slide have a rubber cushioning that absorb a fall. Outdoor activity space surface is maintained in a safe condition as is free of hazards. A sufficient shaded area was observed. Lead Teacher states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this. Lead Teacher states there are no weapons or firearms on the premises.

Transportation services are not provided at this facility. Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. LPA observed all children present to be signed in.



LPA did not review staff files during the inspection due to the staff files being stored at the administrative office located at Williams Head Start. LPA will review staff files at a later time and date.

Children’s Records were reviewed to ensure that the following are present: LIC 613A Personal Rights, Admission Agreement, LIC 700 Identification and Emergency form, LIC 701 Physician’s Report, LIC 995 Notification of Parent’s Rights, LIC 627 Consent for Emergency Medical Treatment and Immunization Record.

*REPORT CONTINUES ON NEXT PAGE
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLARD HEAD START
FACILITY NUMBER: 191500284
VISIT DATE: 08/24/2022
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This facility provides Incidental Medical Services – IMS. Storage of medication, medications and documentation was reviewed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The licensee’s email address was obtained during this visit. The licensee was advised that email is public information.

There were no deficiencies given during this inspection.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director, Venneka Powell-Shannon.

*END OF REPORT

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC809 (FAS) - (06/04)
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