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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191805630
Report Date: 10/07/2024
Date Signed: 10/07/2024 03:28:26 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/07/2024 03:28 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:JOSEPH A. GASCON ELEMENTARY HEAD STARTFACILITY NUMBER:
191805630
ADMINISTRATOR/
DIRECTOR:		MARIANA SANCHEZFACILITY TYPE:
850
ADDRESS:630 S. LEONARD AVE.TELEPHONE:
(323) 721-2025
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
10/07/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Vanessa Guzman, Education SpecialistTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On October 7, 2024, Licensing Program Analysts (LPAs) Monique Ayala and Carolyn Tuba conducted an unannounced Case Management- Annual Continuation at 123 S. Montebello Blvd. Montebello, CA 90640. The purpose of the inspection is to review staff files from the above facility. LPAs met with Education Specialist Vanessa Guzman and Executive Assistant 1 Yanel Preciado who provided LPAs with staff files.

LPAs reviewed 5 staff files and files were not found to be complete, Staff #1 (S1) to Staff #3 (S3) are missing the influenza vaccine/decline waiver, Staff #2 (S2) and Staff #4 (S4) are missing MMR vaccine, S3 and Staff #5 (S5) are missing LIC503 (Health Screening) and S5 is missing all required immunization (MMR, TDap and Influenza)

The facility is being cited two Type B deficiencies in accordance with Title 22 Regulations, see LIC809D.

An exit interview was conducted and a copy of this report was provided along with Appeal Rights. Notice of Site Visit was provided to Education Specialist, Vanessa Guzman and must be posted at the facility for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2024
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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Document Has Been Signed on 10/07/2024 03:28 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 10/07/2024 at 02:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: JOSEPH A. GASCON ELEMENTARY HEAD START
FACILITY NUMBER: 191805630

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/01/2024
Section Cited
CCR
101217(a)(11)

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Personnel Records: The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: A health screening as specified in Section 101216(g). This requirement was not met as evidence
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Per Education Specialist, Vanessa Guzman will ensure that the health screening is complete by POC date (11/01/2024)
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by: Based on record review, LPAs Ayala and Tuba did not observe a health screening in Staff #3 and Staff #5 file. This poses a potential health and safety risk for children in care.
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Type B
11/01/2024
Section Cited
HSC1596.7995(a)(1)

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Employees or volunteers at day care center; immunization requirements; records; exemptions: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee shall
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Per Education Specialist, Vanessa Guzman will ensure that the staff immunizations are complete by POC date (11/01/2024)
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receive an influenza vaccination between August 1 and December 1 of each year. This requirement was not met as evidence by: Based on record review Staff #1 to Staff #5 do not have compelte immunizations on file. This poses an potential health and safety riske 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:Ana Chico
LICENSING EVALUATOR NAME:Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2024


LIC809 (FAS) - (06/04)
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