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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018034
Report Date: 06/28/2022
Date Signed: 06/28/2022 03:57:17 PM

Document Has Been Signed on 06/28/2022 03:57 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MAOF HEAD START - LEW SANDS WELTORFACILITY NUMBER:
198018034
ADMINISTRATOR:SONIA GUERREROFACILITY TYPE:
850
ADDRESS:1010 E. 48TH STREETTELEPHONE:
(323) 233-2573
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY: 72TOTAL ENROLLED CHILDREN: 48CENSUS: 34DATE:
06/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:TIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) T. Tran arrived at the above licensed facility to conduct a Case Management Incident occurred on 02/28/2022. The Monterey Park South West Office received the writing report on 03/01/2022. During the inspection, LPA observed proper care and supervision.

LPA completed child and staff’s files reviewed. LPA obtained child's document and personnel report.
Based on the interview conducted with staff and other, it revealed that child had no record of febrile seizure. This was the first incident occurred and staff were implementing the emergency protocol to assist child. 911 and parent were contacted immediately. Facility had developed history of febrile seizures care plan upon child returned to school. No new episodes observed at school or home. Per staff, on the day of the incident there were seven children with two staff.

No deficiency was found during today's inspection. 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, Sylvia Larralde.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
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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