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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021114
Report Date: 03/18/2024
Date Signed: 03/18/2024 02:38:00 PM

Document Has Been Signed on 03/18/2024 02:38 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:MONTEBELLO USD FREMONT ELEMENTARYFACILITY NUMBER:
198021114
ADMINISTRATOR:OROSCO, DANIELFACILITY TYPE:
830
ADDRESS:200 W MADISON AVENUETELEPHONE:
(323) 721-2435
CITY:MONTEBELLOSTATE: CAZIP CODE:
91754
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
03/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Ashley Garcia, Head TeacherTIME COMPLETED:
02:50 PM
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On 03/18/2024, Licensing Program Analysts (LPAs) Kruz Long and Priscilla Ochoa conducted an unannounced case management inspection. A COVID-19 risk assessment was conducted prior to entering the facility. LPAs met with Ashley Garcia, Head Teacher who guided LPAs on a tour of the facility. LPAs observed 5 children with 3 staff members. A short time later Maria Gonzalez, Early Head Start Teacher on Special Assignments arrived at the facility and assisted with the inspection.

The purpose of the visit is to follow up on an incident that occurred on 03/14/2024 and was reported to the department on 03/15/2024 (reported timely). The self reported incident is regarding personal rights/supervision.

During this inspection, LPAs toured the facility and interviewed Staff #1 (S1) and Staff #2 (S2).

Based on LPA's observations, the play ground did not contain any tripping hazards and the toys were age appropriate. Interviews with staff members indicate there was sufficient supervision during the time of incident. There's no corroborating evidence indicating a violation of personal rights or supervision had occurred.

No deficiencies being cited during today's investigation.

An exit interview was conducted and a copy of this report was provided to Maria Gonzalez, Early Head Start Teacher on Special Assignments. A Notice of Site Visit was provided; Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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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