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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015475
Report Date: 11/19/2024
Date Signed: 11/19/2024 02:41:58 PM

Document Has Been Signed on 11/19/2024 02:41 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/
DIRECTOR:		DEBBIE GIPSONFACILITY TYPE:
850
ADDRESS:3020 SOUTH CATALINA STREETTELEPHONE:
(213) 743-4651
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 45TOTAL ENROLLED CHILDREN: 30CENSUS: 28DATE:
11/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Kenicia MotaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 11/19/2024, about 1:30 PM, Licensing Program Analysts (LPAs) T. Tran and P. Bowden conducted a case management visit at John W. Mack Center USC Head Start to follow up on a fingerprint clearance for a center staff (see LIC811). About 1:45 PM, LPAs met with Site Supervisor, Kenicia Mota and toured the facility. During this inspection it was determined all employees associated had current criminal background clearances.

Based on evidence obtained during today’s visit, LPAs verified the individual is not present at the facility and has been disassociate the individual from their facility.
LPAs obtained an updated LIC 500.

The facility was found in compliance with Title 22 regulations, no deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted and report was reviewed with the facility representative, Kenicia Mota.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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