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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192005044
Report Date: 11/09/2022
Date Signed: 11/09/2022 03:35:40 PM

Document Has Been Signed on 11/09/2022 03:35 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:ELM STREET HEAD STARTFACILITY NUMBER:
192005044
ADMINISTRATOR:MARSHA BULLOCKFACILITY TYPE:
850
ADDRESS:1425 & 1429 ELM AVENUETELEPHONE:
(562) 218-6220
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY: 85TOTAL ENROLLED CHILDREN: 56CENSUS: 30DATE:
11/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 AM
MET WITH:Jennie Acosta, ELCMTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Katrina Chicote conducted an unannounced case management inspection to follow up on several incidents that was reported to the Department. Upon arrival, LPA met with Jennie Acosta and Judy Long, Early Learning Center Managers (ELCM). LPA toured the facility both indoors and outdoors.

On 09/20/2022, an unusual incident report was made to the department regarding three cases of Hand, Foot, Mouth. Cases were reported to DPH, per DPH guidelines facility was instructed to deep clean, sanitize and disinfect. All children have returned facility with approval of doctor's note.

On 09/27/2022, an unusual incident report was made to the department regarding an incident where two children (siblings) were found to have head lice. Per ELCM, children were excluded from program and were able to return once they cleared head lice check upon arrival by staff.

Per ELCM, anytime there is lice or HFM they have custodians come to facility and conduct a deep clean, they also wrap sheets and wash immediately, and vacuumed. There are also no more soft toys at the facility at this time. Per ELCM, notifications letters were sent home for both exposures.

All incidents were reported to Department within 24 hours and a written report submitted within seven days.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit.

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.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Jennie Acosta and Judy Long. Report Ends - Page 1 of 1
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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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