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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806026
Report Date: 05/10/2022
Date Signed: 05/10/2022 03:35:48 PM

Document Has Been Signed on 05/10/2022 03:35 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:GREGORY PARK HEAD START/STATE PRE SCHOOLFACILITY NUMBER:
191806026
ADMINISTRATOR:MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:5807 GREGORY AVE.TELEPHONE:
(323) 463-3061
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 47DATE:
05/10/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Ana Mendez, Child Development Specialist/Temporary Education CoordinatorTIME COMPLETED:
03:50 PM
NARRATIVE
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At 11:41AM an unannounced in-person Case Management-Incident inspection was conducted by Licensing Program Analyst (LPA) Lissete Gonzalez to follow up on an Unusual Incident. The incident was self-reported via telephone on 05/03/2022 to Community Care Licensing. It was reported to the Department that the incident occurred at the facility on 5/02/2022. The facility reported the incident to the Department within the required 24 hours.

Information reported to the Department indicated that Staff #1 violated Child #1's personal rights. Based upon information received from the interviews conducted it was determined that the personal rights of Child #1 were violated by Staff #1. The facility terminated Staff #1’s employment on 5/02/2022. Child #1’s authorized representatives notified and provided with an incident report that indicated Child #1 did not sustain any injuries from the incident. During today’s visit, LPA obtained a letter request to disassociate staff #1 from Foundation for Early Childhood Education facilities.

The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22.



Exit interview conducted and report was reviewed with the facility representative, Ana Mendez.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2022
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 05/10/2022 03:35 PM - It Cannot Be Edited


Created By: Lissete Gonzalez On 05/10/2022 at 02:38 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: GREGORY PARK HEAD START/STATE PRE SCHOOL
FACILITY NUMBER: 191806026

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2022
Section Cited
CCR
101223(a)(3)

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101223(a)(3) Personal Rights
The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions...This requirement was not met as evidenced by:
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Staff #1 was terminated from the facility immediately following the incident. Staff were provided with training on children's safety. A copy of the training topics will be provided to LPA as proof of correction.
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On 5/02/2022 Staff #1 violated the personal rights of child #1. Staff #2 observed and disclosed the incident. This poses a potential health and safety risk 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:Christina Gabelman
LICENSING EVALUATOR NAME:Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022


LIC809 (FAS) - (06/04)
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