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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400484
Report Date: 01/12/2023
Date Signed: 02/01/2023 03:13:37 PM

Document Has Been Signed on 02/01/2023 03:13 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CII/MAIN STREET EARLY HEAD STARTFACILITY NUMBER:
198400484
ADMINISTRATOR:J.LAWRENCE & L. WILLIAMSFACILITY TYPE:
830
ADDRESS:9527 SOUTH MAIN STTELEPHONE:
(323) 905-1042
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY: 22TOTAL ENROLLED CHILDREN: 21CENSUS: 11DATE:
01/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Lakendra WilliamsTIME COMPLETED:
03:40 PM
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About 12:20PM, Licensing Program Analyst (LPA) T. Tran conducted an unannounced Case Management Incident visit at CII Main Street Early Head Start to follow up self-reported incident occurred on 09/12/2022 regarding a child got bit on the forearm while in care. The Monterey Park South West Office received the writing report on 09/16/2022. LPA met with Lakendra Williams, site supervisor. LPA observed proper care and supervision.

LPA completed children and staff’s files review. LPA obtained child's document, personnel report, and training materials. Interviews were conducted with staff and other. On the day of the incident, there were 7 children with two teachers. 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.

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, Lakendra Williams.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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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