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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018814
Report Date: 06/09/2022
Date Signed: 06/09/2022 04:10:13 PM

Document Has Been Signed on 06/09/2022 04:10 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:SOTO HEAD START PRESCHOOLFACILITY NUMBER:
198018814
ADMINISTRATOR:MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:2616 E. 7TH ST.TELEPHONE:
(626) 572-5107
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 27DATE:
06/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Liliana Aguirre, CDC SpecialistTIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) T. Tran conducted an unannounced Case Management Incident visit at Soto Head Start to follow up self reported incident occurred on 05/20/2022 regards C1 tripped and hit the face on the pavement during outdoor play. The Monterey Park South West Office received the writing report on 05/20/2022. LPA met with Liliana Aguirre, CDC Specialist. LPA observed proper care and supervision.

LPA completed child and staff’s files review. LPA obtained child's document and personnel report.
Interviews were conducted with staff and other. On the day of the incident, there were 5 children with two teachers. Parent was notified upon incident occurred. Based on 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, Liliana Aguirre.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2022
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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