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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419005
Report Date: 02/16/2023
Date Signed: 02/16/2023 03:55:19 PM

Document Has Been Signed on 02/16/2023 03:55 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CII/SOUTH VERMONT HEAD STARTFACILITY NUMBER:
197419005
ADMINISTRATOR:GEORGETTE BRADLEYFACILITY TYPE:
850
ADDRESS:9022 S. VERMONTTELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 24DATE:
02/16/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Georgette BradleyTIME COMPLETED:
04:00 PM
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On 02/16/2023 Licensing Program Analyst ( LPA) Doris Whitmore conducted an unannounced Case Management for the purpose of following up on an Unusual Incident Report( UIR) that occurred on 01/25/2023. Upon arrival, LPA met with Site Supervisor Georgette Bradley and informed the nature of the visit. There was a total of 24 children and 10 staff. The El Segundo Regional Office received an Unususal Incident/injury report on 0130/2023/ The report stated that S#2 disclosed to Site Supervisor that the Parent of Child#1 stated that someone hit her. Mom asked the child who hit you ?and the child pointed to staff#2 and that the mom communicated to the SS that the child is missing so many days od school because staff #2 hit her.
During the investigation LPA Whitmore interviewed Site Supervisor and Staff #1. other staff were not present that worked in classroom where incident occurred. LPA attempted to call the Parent at 3:05p.m. no answer.
LPA obtained Personnel Report LIC500, CII Food Program Attendance Roster & Facility Roster. LPA obtained that additional information is needed.
An exit interview was conducted with Site Supervisor Georgette Bradley. A copy of this report, appeal rights, along with Notice of Site Visit was issued.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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