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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002331
Report Date: 04/18/2024
Date Signed: 04/18/2024 04:11:50 PM

Document Has Been Signed on 04/18/2024 04:11 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:MAOF HEAD START WALNUT CENTERFACILITY NUMBER:
198002331
ADMINISTRATOR/
DIRECTOR:
ESCOBAR, REBECCAFACILITY TYPE:
850
ADDRESS:7818 S. PACIFIC BLVD.TELEPHONE:
(323) 584-2928
CITY:HUNTINGTON PARKSTATE: CAZIP CODE:
90255
CAPACITY: 45TOTAL ENROLLED CHILDREN: 33CENSUS: 24DATE:
04/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Adelia EscobedaTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) T. Tran arrived at the above facility to conduct a Case Management Incident inspection to follow up on the self-reported incident that occurred on 3/20/24. Upon arrival, LPA met with head teacher, Adelia Escobda. LPA observed proper care and supervision.

LPA completed child, staff’s records review then obtained child's document and personnel report. Interview was conducted with staff, child, and other during today's visit.
Based on interviews conducted and record reviewed, it appears that the facility had followed the health and safety protocol to ensure a new enrolled child's food allergies is updated. Facility had made the required milk accommodation to meet the child's need.

No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.
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 conducted and report was reviewed with the facility representative, Adelia Escobeda.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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