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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400390
Report Date: 06/03/2022
Date Signed: 06/03/2022 10:34:17 AM

Document Has Been Signed on 06/03/2022 10:34 AM - 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:HERRERA HEAD STARTFACILITY NUMBER:
198400390
ADMINISTRATOR:DIGGS, LASHELLFACILITY TYPE:
850
ADDRESS:1620 TEMPLE AVE.TELEPHONE:
(562) 426-8144
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY: 40TOTAL ENROLLED CHILDREN: 41CENSUS: 19DATE:
06/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Jenny Acosta, Program AdministratorTIME COMPLETED:
10:45 AM
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 Licensing Program Analysts (LPAs) Rita Ramos and Katrina Chicote conducted an unannounced case management visit on 06/03/22. LPAs arrived at the facility at 09:10AM and met with Teacher Joanna Olmos who provided a tour of the facility. There were 19 children with 6 staff upon arrival. LPAs were later met by, Jenny Acosta, Program Administrator.

The purpose of the visit was to follow-up on an incident reported to the department on 04/13/22. Information provided to the department indicates that Child #1s personal rights may have been violated. LPA Ramos had initially followed-up on this incident on 04/29/22.

During today's visit LPAs conducted interviews and obtained copies of documentation.

Due to insufficient information at this time, LPAs will need to return on another date and time.

Exit interview was conducted with Jenny Acosta, Program Administrator, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days.
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2022
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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