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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870897
Report Date: 05/03/2022
Date Signed: 06/09/2022 10:33:28 AM

Document Has Been Signed on 06/09/2022 10:33 AM - 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:USC HEAD STARTFACILITY NUMBER:
191870897
ADMINISTRATOR:JOANNA WILLIAMSFACILITY TYPE:
850
ADDRESS:741 WEST 27TH STREETTELEPHONE:
(213) 743-2466
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 119TOTAL ENROLLED CHILDREN: 117CENSUS: 103DATE:
05/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Leticia Rodriguez, Site SupervisorTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) T. Tran arrived at USC Head Start to conduct an unannounced Case Management inspection that was self-reported on 02/28/2022 regarding a child in care fell off the double bike. The Monterey Park South West Child Care Regional Office received the incident report on 02/18/2022. About 2:15 PM, Site supervisor, Leticia Rodriguez provided LPA a tour of the facility. LPA observed dismissal time with proper care and supervision.

LPA completed files review for staff, children, and obtained child's record. Based on the information that were gathered through interviews with staff and other. On the day of the incident, there were three staff supervised 16 children. According to the available information, it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

No deficiency was 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 facility representative, Leticia Rodriguez

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2022
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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