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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019203
Report Date: 02/11/2022
Date Signed: 02/11/2022 01:28:32 PM

Document Has Been Signed on 02/11/2022 01:28 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ROOSEVELT HEAD STARTFACILITY NUMBER:
198019203
ADMINISTRATOR:LA TUNYA FISHERFACILITY TYPE:
850
ADDRESS:1574 LINDEN AVETELEPHONE:
(562) 218-1164
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY: 24TOTAL ENROLLED CHILDREN: 22CENSUS: 4DATE:
02/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:41 PM
MET WITH:Natasha Jackson, Early Learning Center ManagerTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection due to 2 incidents that were reported to the Department. LPA met with Natasha Jackson, Early Learning Center Manager. There were 4 children and 4 staff present during this inspection.

The purpose of the visit was to follow-up on 2 incidents that were reported to the department.

LPA Ramos conducted interviews and obtained documentation during this visit.

The incident that occurred on 01/25/22, was reported to the Department on 01/26/22, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence. The incident that occurred on 01/26/22 was reported to the Department on 01/27/22, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence

Information reported to the Department on 01/26/22 indicated that Staff #1 violated Child #1's personal rights. Information reported to the Department on 01/27/22 indicates that Child #2's personal rights were violated.

Based upon information received from the interviews conducted it was determined that there is not enough information to determine if Child #1s personal rights were violated. Child #2 was an incident that staff were mandated to report and followed through with procedures.

There were no deficiencies cited during today’s inspection. 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. Exit interview was conducted with Natasha Jackson, Early Learning Center Manager. including, but not limited to Provider Rights, Appeal Procedures.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2022
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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