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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500256
Report Date: 12/03/2024
Date Signed: 12/03/2024 09:39:05 AM

Document Has Been Signed on 12/03/2024 09:39 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WILLIAMS HEAD STARTFACILITY NUMBER:
191500256
ADMINISTRATOR/
DIRECTOR:		ROSA GUERRAFACILITY TYPE:
850
ADDRESS:2444 N. DEL MAR AVE.TELEPHONE:
(626) 307-3400
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY: 188TOTAL ENROLLED CHILDREN: 18CENSUS: 13DATE:
12/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Erica Vega, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
09:50 AM
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On 12/03/2024, Licensing Program Analyst (LPA) Kruz Long conducted an unannounced case management inspection. A COVID-19 risk assessment was conducted. LPA met with Erica Vega, Program Manager and explained the purpose of the visit. There are 18 children enrolled and 13 are present with 2 Staff in Classroom #9.

The purpose of the visit is to follow up on an incident that occurred on 11/21/2024 and was reported to the department on 11/22/24. The self reported incident is regarding supervision and physical environment.

During today's inspection, LPA toured the outdoor area with the Program Manager, interviewed Staff #1 (S1) and attempted to interview to Staff #2 (S3) and Child #1 (C1).

Due to insufficient information available at this time, this incident needs further investigation.

An exit interview was conducted and a copy of this report was provided to the Program Manager.

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: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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