198020296-4-23-2026-33-CC-POCA-DTERAM-20260423125122

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020296
Report Date: 04/23/2026
Date Signed: 04/23/2026 12:51:28 PM

Document Has Been Signed on 04/23/2026 12:51 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	PARA LOS NINOS EARLY HEAD START: VINE		FACILITY NUMBER:	198020296
ADMINISTRATOR/ DIRECTOR:	ANGELA CAPONE		FACILITY TYPE:	830
ADDRESS:	1147 VINE ST		TELEPHONE:	(213) 250-4800
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90038
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 29	CENSUS: 25	DATE:	04/23/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:10 AM
MET WITH:	Site Supervisor, Lilian Rubio		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

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On April 23, 2026, Licensing Program Analysts (LPA) Priscilla Ochoa conducted an unannounced case management inspection for the above facility. LPA was greeted by Site Supervisor, Lilian Rubio, who guided LPA on a tour of the facility. The purpose of this inspection is to follow up on a self-reported incident that occurred at the facility on 04/14/2026. This is an infant program that operates Monday – Friday from 8 am – 4 pm. Per Site Supervisor there are 29 infants enrolled and LPA observed 25 infants with 10 staff members.

Brief summary of incident: Child #1 (C1) was doing an activity in the classroom, when C1 turned around and lost balance. C1 fell forward and hit their head on the book shelf. Resulted in a slight bruise on their forehead.

During this inspection, LPA interviewed Staff #1 (S1) - Staff #3 (S3) and observed the area where the incident occurred. LPA did not interview C1 as C1 is an infant.

Per S2, they were blowing bubbles on the carpet area in the classroom. C1 was right in front of S2 when C1 tried to turn around really fast and lost their balance causing them to fall forward and hit their forehead on the second shelf of the book shelf. S2 mentioned that C1 was wearing bulky shoes and caused C1 to trip over their feet when they tried to turn around. Per S2 and S3, C1 had a small yellow bruise on C1 forehead but diminished when ice was provided by S2. Per S1, since C1 sustained a head injury its the facilities policy for the child to be picked up and taken to seek medical attention. C1 retuned to the facility with a medical clearance letter on 4/16/2026 with no restrictions. LPA observed the area where the incident occurred and did not identify any hazards.

Based on interviews and observations conducted there was no corroborating information to determine that there was a lack of supervision during this incident. The incident was deemed an accident. All reporting requirements were met. There are no deficiencies being 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 Site Supervisor, Lilian Rubio.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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