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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015475
Report Date: 09/26/2023
Date Signed: 09/26/2023 03:28:31 PM

Document Has Been Signed on 09/26/2023 03:28 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:JOHN W. MACK CENTER, USC HEAD STARTFACILITY NUMBER:
198015475
ADMINISTRATOR:DEBBIE GIPSONFACILITY TYPE:
850
ADDRESS:3020 SOUTH CATALINA STREETTELEPHONE:
(213) 743-4651
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 45TOTAL ENROLLED CHILDREN: 30CENSUS: 26DATE:
09/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Joanna WilliamsTIME COMPLETED:
03:45 PM
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On 09/26/2023, Licensing Program Analyst (LPA) T. Tran arrived at John W. Mack Center USC Head Start to conduct a Case Management inspection that was self-reported on 09/07/2023 regarding to a child in care personal rights. The Monterey Park South West Child Care Regional Office received the incident report on 09/07/2023. Upon arrival, LPA met with Joanna Williams, Associated Director who provided LPA a tour of the center. LPA observed children were napping. LPA observed proper care and supervision and ratio.

LPA complete staff and child files review. LPA obtained LIC 500, staff, and child documents. Interviews were conducted with staff, child, and other. On the day of the incident, a fully qualified staff supervised 13 napping children and observed C1 unusual behavior (See LIC 812 for more detail) and immediately called site supervisor for assistance then paramedic and parent were contacted. Child has been released to return to school on 9/11/23 without any restrictions.

Based on the information that were gathered during today's interviews, it does not appear this incident was the result of a Title 22 violation for children's personal rights.

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 Joanna Williams.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023
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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