Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500278
Report Date: 03/06/2020
Date Signed: 03/06/2020 12:22:27 PM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SANCHEZ HEAD STARTFACILITY NUMBER:
191500278
ADMINISTRATOR:CAROLYN WONGFACILITY TYPE:
850
ADDRESS:8470 E. FERN AVETELEPHONE:
(626) 927-5790
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:18CENSUS: 15DATE:
03/06/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Millie Lim Wong, TeacherTIME COMPLETED:
12:36 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Lissete Gonzalez Nolan Tcheng conducted an unannounced Case Management Incident inspection due to an incident reported to the Department on 2/21/2020. LPAs met with Head Teacher, Millie Lim Wong. Census was taken.

On 2/21/2020, an unusual incident report was made to the department via fax for an incident that occurred on 2/19/2020 which involved an allegation made against a staff member at the facility regarding personal rights of children in care. The incident was reported to the Department within the required 24 hours. The purpose of the inspection was to obtain additional information regarding the allegation reported to the department. During the inspection, LPAs conducted interviews with staff, children and reviewed documentation. Due to insufficient information available at this time, a follow up visit will be required at a later date.

Exit interview was conducted with Head Teacher, Millie Lim Wong. Appeal rights discussed and explained.


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. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1