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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191805822
Report Date: 09/26/2024
Date Signed: 09/26/2024 12:15:36 PM

Document Has Been Signed on 09/26/2024 12:15 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:EVANS HEAD START/STATE PRESCHOOLFACILITY NUMBER:
191805822
ADMINISTRATOR/
DIRECTOR:		MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:717 N. FIGUEROA ST.TELEPHONE:
(213) 628-8865
CITY:LOS ANGELESSTATE: CAZIP CODE:
90012
CAPACITY: 16TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
09/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Teacher, Adaih FajardoTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Staicy Perry conducted an unannounced case management inspection to follow up with an incident that was reported to the department. LPA met with teacher, Adaih Fajardo, who guided LPA on a tour of the facility.

On 9/16/2024, it was reported to the department that C#1 was running indoors past a shelf in the classroom when C#1 tripped over their shoes causing C#1 to hit left cheek against the leg of a toddler chair. S#1 did observe the incident and attempted to reach C#1 before they fell but was unable to reach C#1 in time. S#1 provided first aid and contacted parent immediately. S#1 stated that P#1 picked up child and took child to doctors as a precaution. C#1 returned to class the following day 9/17/2024 with no restrictions.The incident was reported to the Department within the 24-hour period and the written report was received via email on 9/17/2024.

During today’s inspection, declaration were obtained, photos taken and documentation was reviewed and obtained. C#1 fell- incident was observed and first aid was provided. C#1 returned to school the following day with no restrictions. Per teacher, Adaih Fajardo staff reminded all children to use walking feet. Based on information obtained from S#1, there were no corroborating information to determine that there was a lack of supervision during the incident.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with teacher, Adaih Fajardo.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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