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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002482
Report Date: 06/01/2023
Date Signed: 06/01/2023 02:57:44 PM

Document Has Been Signed on 06/01/2023 02:57 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MAOF HEAD START ZOE AVENUE CENTERFACILITY NUMBER:
198002482
ADMINISTRATOR:CYNTHIA RODRIGUEZFACILITY TYPE:
850
ADDRESS:2650 ZOE AVE.TELEPHONE:
(323) 584-5828
CITY:HUNTINGTON PARKSTATE: CAZIP CODE:
90255
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 70DATE:
06/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Martha ArellanoTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) T. Tran conducted an unannounced Case Management Incident visit at Zoe Avenue Center to follow up self reported incident occurred on 05/19/2023. The Monterey Park South West Office received the writing report on 05/19/2023. Upon arrival, LPA met with Martha Arellano, Lead Teacher and we toured the facility. LPA observed proper care and supervision.

LPA completed children and staff’s files review. LPA obtained children's document and personnel report.

Interviews were conducted with staff, children, and other. On the day of the incident, there were 13 children with two teachers. S1 attempted to intervene C1 from chocking a peer then she fell and bruised her knee. Both children were fine. Parent was notified. 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 cited at this time. 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, Martha Arellano.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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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