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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191606622
Report Date: 04/18/2024
Date Signed: 04/18/2024 10:52:55 AM

Document Has Been Signed on 04/18/2024 10:52 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WILLOW HEAD START/STATE PRESCHOOLFACILITY NUMBER:
191606622
ADMINISTRATOR/
DIRECTOR:		LORA BALLARDFACILITY TYPE:
850
ADDRESS:11733 E. 205TH STREETTELEPHONE:
(562) 229-7954
CITY:LAKEWOODSTATE: CAZIP CODE:
90715
CAPACITY: 37TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
04/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Reema SuleimaTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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About 9:00AM. Licensing Program Analyst (LPA), T. Tran arrived at Willow Head Start to conduct a Annual Required visit. About 9:20AM, LPA met with Teacher, Reema Suleima and toured the facility inside and outside. LPA observed proper care and supervision. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.
Facility hours of operation are 8:30am - 2:30pm Monday - Friday. There is no extended care offered. LPA observed all posting requirements for operation on the posting board LIC 203A-License, LIC 610 A-Emergency Disaster Plan, LIC 9148-Earthquake Preparedness Check List, PUB 394-Notification of parent’s rights poster, LIC 613A- Personal Rights, PUB 269- Child Car Seat Law, Menus, and Activity Schedule. Children Records were reviewed for completeness. Staff records located at the main office. LPA will arrange another visit for files review. LPA observed current CPR and First Aid Certification for all center staff.
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children napping equipment met the requirement regulation. Storage for children's belongings, bathrooms facilities, and isolation areas were inspected. Children drinking water was observed by the use of water sparkletts with paper cups. First Aid supplies were inventoried. A review of medication policy, including administering, labeling, storage, and records was made. Documentation of current Fire & Earthquake drill was observed.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLOW HEAD START/STATE PRESCHOOL
FACILITY NUMBER: 191606622
VISIT DATE: 04/18/2024
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Facility provided breakfast, lunch, and snack. All food items delivered daily from the school cafeteria. Food and snack items are properly stored. Food preparation area was toured for safety, cleanliness, and proper equipment.
Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water.
LPA discussed criminal records/child abuse index clearances & exemptions, child abuse reporting requirements, required licensing forms, capacity limitations, inspection authority, sign-in/sign-out log importance, incident/medication documentation, reporting requirements, licensee appeal/procedure rights & agency's consultative role.
LPA advised to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations and PINs. LPA informed the Child Care Advocate Program (CCAP) provide many other helpful resources to the licensees and the public. Visit www.cdss.ca.gov to receive important updates.
LPA informed the effects of lead exposure for children between ages 1-6 years old are the most at risk for lead poisoning. A copy of lead exposure was provided.
Facility was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B). Facility is reminded that smoking is prohibited on the premises.
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. Facility representative 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.
No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.
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. Failure to maintain posting as required will result in a civil penalty of $100.00.
Exit interview conducted and report was reviewed with the facility representative, Reema Suleima.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
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