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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593621
Report Date: 12/22/2022
Date Signed: 12/22/2022 02:24:29 PM

Document Has Been Signed on 12/22/2022 02:24 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MONTE VISTA HEAD START/STATE PRESCHOOLFACILITY NUMBER:
191593621
ADMINISTRATOR:ALMA GONZALEZFACILITY TYPE:
850
ADDRESS:11111 THIENES AVE.TELEPHONE:
(626) 652-4250
CITY:EL MONTESTATE: CAZIP CODE:
91733
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 0DATE:
12/22/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Director, Alma Gonzalez TIME COMPLETED:
11:40 AM
NARRATIVE
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At 10:50 am Licensing Program Analyst (LPA) Roxana Lopez conducted an annual continuation visit to Mountain View School District Office located on 2109 Burkett Rd South El Monte, CA 91733. The purpose of this inspection is to review staff and children files as they were not available for review at the Monte Vista Head Start facility during the Annual inspection conducted on 11/01/2022. LPA met with Alma Gonzales, Director who provided LPA with staff and children files for review.

Staff and Children’s Records were reviewed for completeness: Inspections of required forms was made.

LPA issued the Review of Children's Records (LIC 857) and the Review of Staff's Records (LIC 859) to the facility representative during this inspection. The LIC 857 documents the children’s files that were reviewed during this inspection. The LIC 859 documents the staff's files that were reviewed during this inspection.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided.

Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov.

For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTE VISTA HEAD START/STATE PRESCHOOL
FACILITY NUMBER: 191593621
VISIT DATE: 12/22/2022
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated

At this time, the facility is in compliance with California Code of Regulations Title 22. No deficiencies cited.

Exit interview conducted and report was reviewed with Director Alma Gonzalez.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
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