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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019355
Report Date: 02/26/2025
Date Signed: 02/26/2025 03:48:25 PM

Document Has Been Signed on 02/26/2025 03:48 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:CII/JORDAN DOWNS HEAD STARTFACILITY NUMBER:
198019355
ADMINISTRATOR/
DIRECTOR:		MARTA RODRIGUEZFACILITY TYPE:
850
ADDRESS:9880 S. GRAPE STREETTELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY: 32TOTAL ENROLLED CHILDREN: 31CENSUS: 8DATE:
02/26/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Elizabeth VasquezTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analysts (LPAs) T. Tran and L. Voong arrived at Children’s Institute Inc. Jordan Downs Head Start to conduct a Case Management inspection that was self-reported on 02/06/2025 regarding head injury incident. The Monterey Park South West Child Care Regional Office received the incident report on 2/06/2025. Upon arrival, LPAs announced the purpose of our visit. LPAs met with Site Supervisor, Elizabeth Vasquez and toured the facility. LPAs observed proper care and supervision.

LPAs completed files review for staff and child. LPAs obtained children's attendance, personnel report, and other documents. Based on record review and interview conducted on 2/6/25, there were 3 staff with 5 children. Per staff, around 10:37AM during indoor music and movement activity C1 lost balance then fell back hitting the left side of the head against the edge of the shelve. Child sustained a cut on the left side of the head. Staff immediately provided first aid and parents were contacted. At this time 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.

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.
Exit interview conducted and report was reviewed with the facility representative Elizabeth Vasquez.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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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