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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021531
Report Date: 09/16/2025
Date Signed: 09/16/2025 01:56:47 PM

Document Has Been Signed on 09/16/2025 01:56 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:COGSWELL HEAD START/STATE PRESCHOOLFACILITY NUMBER:
198021531
ADMINISTRATOR/
DIRECTOR:		ALMA GONZALESFACILITY TYPE:
860
ADDRESS:11050 FINEVIEW ST.TELEPHONE:
(626) 652-4250
CITY:EL MONTESTATE: CAZIP CODE:
91733
CAPACITY: 60TOTAL ENROLLED CHILDREN: 48CENSUS: 38DATE:
09/16/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Samara BakerTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Case Management Incident inspection at the above facility on 09/16/25 at 12:00p.m. The purpose of this inspection is to follow up on an incident reported to the Department on 09/10/25. LPA met with the program manager Samara Baker who guided LPA on a tour.

During today’s inspection, LPA conducted interviews with staff 1 (S1 thru 3), and child 1 (C1). LPA took pictures of the Care and Supervision procedures for 2025-2026, General Consent form, and teachers office. LPA requested additional documentation regarding speech services practices/procedures which will be submitted to LPA. LPA will review Care and Supervision procedures, general consent form, and the MOU at a later date.

On 09/09/25, at approx. 10:20 am child 1 (C1) was in a small group speech session with the speech pathologist (S1) inside the teacher’s office. S1 provided a magnetic letter A to C1 while they worked with another child. S1 recalled hearing C1 ask for help and when they turned to look at C1 they observed that the child had placed the magnetic letter A on their left middle finger. S1 noticed that the letter was stuck, and they immediately attempted to help remove the magnetic letter; however, they were very cautious on how they were going to remove the letter to ensure that C1 was not harmed. As S1 attempted to remove the letter, they observed that the letter was really stuck and walked over with both children to the sink and placed soap with water in an effort to remove the magnetic letter. Once S1 realized that the magnetic letter was still stuck they requested assistance from staff 2 (S2) who was walking into the classroom. According to S2, they were walking into the classroom when S1 asked for assistance in removing the stuck magnetic letter on C1.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2025
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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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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: COGSWELL HEAD START/STATE PRESCHOOL
FACILITY NUMBER: 198021531
VISIT DATE: 09/16/2025
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Per S2, they added Dawn soap with water and attempted to remove the magnetic letter; however, it was still stuck. Staff also added baby oil in an effort to remove the magnetic letter; however, it did not help either. S2 observed that C1’s finger was swollen and began to turn purple. Staff called the program manager, principal, C1s parents, and 911.

Parent of C1 arrived and observed the paramedics and EMT working on removing the magnetic letter from C1. The program manager and principal arrived prior to the paramedics and EMT arrival to the facility. Per S3, they stepped into the classroom to assist staff with the rest of the children while the principal stayed with the paramedics, EMT, S1, S2, C1, and parent of C1.

According to S1 and S2, the paramedics successfully removed the magnetic letter without harming C1 and no injuries were observed. According to staff interviewed, parents of C1 were asked to take the child to the doctor for a follow up and requested a doctor’s note upon the child’s return to the facility. Per S3, the child was cleared to return to the facility on 09/10; however, the facility was closed and the child returned on 09/11 without any restrictions. LPA attempted to interview C1 and observed that when asked what happened to their finger, C1 seemed to motion and demonstrate that the magnetic letter was stuck; however, C1 is not fully verbal. LPA observed that C1s hand and fingers appear normal with no visual injuries. Per staff, C1 is able to move all fingers with no restrictions.

LPA did not observe the magnetic letters during the inspection since S1 is no longer providing those magnets during the speech sessions. S1 stated that the magnetic letters are from Lakeshore; however, cannot confirm either since the label was torn. Per S1, the magnetic letters are age appropriate and have been very useful at other speech sessions; however, S1 has decided not to bring the magnetic letters to the speech sessions. Staff interviewed revealed that this was a 1 time incident.

At this time, the above allegation requires further investigation. The licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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, a civil penalty of $100 can be assessed.

An exit interview was conducted, and a copy of this report was provided to program manager Samara Baker.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC809 (FAS) - (06/04)
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