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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013571
Report Date: 09/11/2025
Date Signed: 09/11/2025 12:55:42 PM

Document Has Been Signed on 09/11/2025 12:55 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:VOLUNTEERS OF AMERICA, SUNOL HEAD STARTFACILITY NUMBER:
198013571
ADMINISTRATOR/
DIRECTOR:		ROKEYA RAHMANFACILITY TYPE:
850
ADDRESS:133 N. SUNOL AVENUETELEPHONE:
(323) 980-8570
CITY:LOS ANGELESSTATE: CAZIP CODE:
90063
CAPACITY: 58TOTAL ENROLLED CHILDREN: 9CENSUS: 6DATE:
09/11/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Facility Representative, Gabriela RodriguezTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On September 11, 2025, at 10:00 am Licensing Program Analyst (LPA) Monica Ruiz conducted a case management inspection due to a self reported incident that occurred at the facility on 9/8/2025. LPA met with Site Supervisor Gabriela Rodriguez. A Covid Risk Assessment was conducted. LPA took a census of 6 children with 2 staff in Class 4. There are 9 children enrolled in class 4.

LPA conducted interviews with Site Supervisor, Preschool Teacher (Staff 1) and Co-Teacher (Staff 2) regarding this incident, names were recorded. Staff 1 and Staff 2 state that on 9/8/2025, they were both standing at one end of the play area, watching the children play, there were 7 children in attendance with 2 staff members.


Staff 1 states Child 1 (C1) was running around the bike path with friends, then ran onto artificial grass, when he suddenly fell. Staff 1 and 2 state that C1 put out their right arm but landed with all their body weight on their left arm. Staff 1 and 2 stated they did not see C1 trip over anything and when C1 got up, they had a scared look on their face, holding their left arm and crying. C1 is non-verbal and Spanish is their primary language. C1 was unable to explain which part of their arm hurt or what caused them to fall.
S1 provided C1 with an ice-pack and left C1 to be attended by S2. Site Supervisor called 911 and the Family Advocate called C1’s mother. C1’s mother rode in the ambulance with C1, to the county hospital. Doctors took x-rays, discovered C1 had a fractured elbow, and a cast on their left arm was provided. C1’s mother informed Site Supervisor that C1 will stay home for the remainder of the week and will return the following week. Facility staff will be trained on C1’s restrictions while arm is in cast and C1’s mother will be allowed to stay with C1 upon return until C1 is acclimated to classroom. (report continued on next page...)
NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: VOLUNTEERS OF AMERICA, SUNOL HEAD START
FACILITY NUMBER: 198013571
VISIT DATE: 09/11/2025
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LPA inspected outdoor play area and observed the playground to be fully fenced. LPA observed there to be tricycles, a bike path, water activity table, and play structures for climbing and balancing. There is shade in the play yard. LPA advised Site Supervisor to maintain cushioning under outdoor equipment and to maintain a fall space around climbing equipment.

LPA observed the surface that child 1 (C1) landed on to be cushioned to absorb a fall. LPA did not observe any defects in the surface of the cushioned outdoor play area or tripping hazards. LPA observed playground equipment to be in good condition, age appropriate, with no loose, sharp or pointed parts. LPA advised Site Supervisor to remind staff to constantly reassess and maintain active supervision zones while on playground.

During this visit LPA obtained the Childcare Facility Roster, the V.O.A Child Incident Report, Children’s Services Center Incident Form, Count of Los Angeles Non-Employee Injury/Property Damage Report, Personnel Report (LIC 500), child’s file, and copy of child’s emergency room discharge report.

Site Supervisor states that the Director and staff will discuss this incident and types of children’s shoes allowed on playground with the facility’s Safety Team.

The incident was reported to the Department within the required 24 hours of occurrence.

At this time, the facility is in compliance with California Code of Regulations Title 22, therefore no deficiencies were cited during today’s visit inspection.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Site Supervisor, Gabriela Rodriguez.

NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC809 (FAS) - (06/04)
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