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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870702
Report Date: 05/19/2026
Date Signed: 05/19/2026 12:24:21 PM

Document Has Been Signed on 05/19/2026 12:24 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: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: 48CENSUS: 42DATE:
05/19/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Lead teacher, Martiza ResendesTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On May 19, 2026, Licensing Program Analysts (LPA) Priscilla Ochoa conducted an unannounced case management inspection for the above facility. LPA was greeted by the Lead Teacher, Martiza Resendez, who guided LPA on a tour of the facility. The purpose of this inspection is to follow up on a self-reported incident that occurred at the facility on 05/08/2026. This is a preschool program with a toddler component that operates Monday – Friday from 7:45 am – 4:30 pm. LPA observed 42 children in care along with 9 staff members.

Brief summary of incident: Child #1 (C1) who is in the preschool program was running around a four ring storage basketball stand on the playground when C1 rand into a ring and hit the bridge of their nose.

During this investigation, LPA interviewed Staff 1 (S1) and C1, observed the four ring storage basketball stand where the incident occurred, and reviewed C1 doctor’s note and incident report that was documented.

Based on interviews, S1 was supervising 12 children on the preschool playground and observed C1 and a group of children running around the four ring storage basketball stand on the grass area. Per S1, C1 was not paying attention and ran into a basketball ring, hurting the upper bridge of their nose. S1 mentioned, first aid in the form of an ice pack was applied and C1 sat down for about 5 minutes. Once C1 was ready they continued to play. C1 expressed that they were running and did not see the basketball ring when they crashed into it. C1 showed LPA that they got hurt on the bridge of their nose. Per C1, a staff member applied an ice pack and had them sit down for a little bit to relax. S1 expressed that the parent was called but was not available. The facility then contacted a person from the child’s emergency contact to inform them what had occurred.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FOUNTAIN AVENUE HEAD START
FACILITY NUMBER: 191870702
VISIT DATE: 05/19/2026
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During pick up, the facility explained to the parent what had occurred and took C1 to seek medical attention. The child returned to the facility on 5/11/2026, with no restrictions.

C1 did sustain a minor bruise to the bridge of their nose.

Based on interviews and observations conducted there was no corroborating information to determine that there was not a lack of supervision during the incident. The incident was deemed an accident. LPA inspected the four ring storage basketball stand on the grass area and determined that it is age appropriate for preschool aged children. However, LPA did observe that the basketballs rings are a hard plastic. LPA consulted with Lead teacher, provided technical assistance and suggested that a cushion or padding be added to the basketball rings to ensure incidents like this do not occur moving forward.

All reporting requirements were met. There are no deficiencies being cited at this time.

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

Exit interview conducted and report was reviewed with the Lead Teacher, Martiza Resendez.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
LIC809 (FAS) - (06/04)
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