198005683-9-13-2022-33-CC-RLOZ-CJ8NZG-20220913105420

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198005683
Report Date: 09/13/2022
Date Signed: 09/13/2022 10:54:26 AM

Document Has Been Signed on 09/13/2022 10:54 AM - 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:	MONTEBELLO GARDENS HEAD START		FACILITY NUMBER:	198005683
ADMINISTRATOR:	MARIANA SANCHEZ		FACILITY TYPE:	850
ADDRESS:	4700 PINE ST.		TELEPHONE:	(562) 908-1073
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY: 42	TOTAL ENROLLED CHILDREN: 52	CENSUS: 0	DATE:	09/13/2022
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Dr. Valdez, Director of Human Resources		TIME COMPLETED:	11:00 AM

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At 9:00 am Licensing Program Analyst (LPA) Roxana Lopez conducted an annual continuation visit to Montebello Unified School District. An attempted visit was conducted on 9/8/2022. The purpose of this inspection is to review staff files as they were not available for review at the Montebello Gardens Head Start facility during the Annual inspection conducted on 9/8/2022. LPA met with Dr. Valdez, Director of Human Resources who provided LPA with the staff files of the staff present during the inspection.

Facility Records: All staff have received an active criminal record clearance as a condition of their employment with the Montebello Unified School District

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

SB792 (Immunization Requirements for Staff and Employees) was discussed with Dr. Valdez. Staff files do not currently have required immunizations documentation on file. A technical violation was given on this date.

LPA’s issued the Review of Staff Records (LIC 859) to the licensee during this inspection. The LIC 859 documents the staff’s files 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.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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: MONTEBELLO GARDENS HEAD START	FACILITY NUMBER: 198005683
	VISIT DATE: 09/13/2022

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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.

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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Dr. Valdez

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

LIC809 (FAS) - (06/04)

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