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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493538
Report Date: 06/26/2024
Date Signed: 06/26/2024 02:56:02 PM

Document Has Been Signed on 06/26/2024 02:56 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:EVERGREEN EARLY LEARNING HEAD STARTFACILITY NUMBER:
197493538
ADMINISTRATOR/
DIRECTOR:
CARDENAS, LAURAFACILITY TYPE:
850
ADDRESS:312 S OLEANDER AVENUETELEPHONE:
3234211100
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 80TOTAL ENROLLED CHILDREN: 76CENSUS: 58DATE:
06/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Candice BondadTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analysts (LPAs) T. Tran and A. Carter made an unannounced visit at Evergreen Early Learning Head Start to conduct a Case Management Incident occurred on 5/28/2024. The Monterey Park South West Office received the writing report on 05/29/2024. Upon arrival, LPAs met with site supervisor, Candice Bondad and toured the facility. LPAs observed proper care and supervision.

LPAs completed child and staff’s files reviewed. LPAs obtained child's document and personnel report.
Based on the interview conducted with staff and other, on the day of the incident, there was a staff supervising 5 children. During outdoor play, S1 observed C1 was running trying to catch with the peers. C1 tripped and landed on the left arm. Staff did not observe no visible injuries. Parent was notified of the incident. Child was taking to the hospital and X-ray showed child had a fracture and needed two wear a half cast. 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 found during today's inspection. 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, Candice Bondad.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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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