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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870702
Report Date: 05/09/2024
Date Signed: 05/09/2024 12:22:00 PM

Document Has Been Signed on 05/09/2024 12:22 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:FOUNTAIN AVENUE HEAD STARTFACILITY NUMBER:
191870702
ADMINISTRATOR/
DIRECTOR:		MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:5636 FOUNTAIN AVE.TELEPHONE:
(323) 962-8557
CITY:LOS ANGELESSTATE: CAZIP CODE:
90028
CAPACITY: 68TOTAL ENROLLED CHILDREN: 68CENSUS: 42DATE:
05/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Liliana Aguirre, Child Development SupervisorTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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On May 9, 2024, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Case Management inspection at the above facility. A COIVID-19 risk assessment was conducted prior to entering the facility. LPA met with Child Developmennt Supervisor Liliana Aguirre who guided LPA on a tour of the facility. LPA observed 42 children in care.

The purpose of the inspection is to follow up on two incident reports that were reported timely to the department. Incident #1 was reported on 01/29/2024 and the incident occurred on 01/29/2024. Incident #2 was reported on 04/19/2024 and occurred on 04/19/2024. Both incidents are being reviewed to ensure possible lack of supervision violation did not occur.

During the investigation, LPA interviewed Staff #1 (S1) to Staff #4 (S4) and obtained a copy of the facility roster.

There are no deficiencies being cited at this time.

An exit interview was conducted and a copy of this report was provided to Child Development Supervisor, Liliana Aguirre. A Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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