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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015324
Report Date: 12/19/2022
Date Signed: 12/19/2022 02:13:13 PM

Document Has Been Signed on 12/19/2022 02:13 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:EL MONTE CITY S.D. - COLUMBIA SCHOOL (HEAD START)FACILITY NUMBER:
198015324
ADMINISTRATOR:LISA DUNBARFACILITY TYPE:
850
ADDRESS:3400 N. CALIFORNIA AVENUETELEPHONE:
(626) 575-2306
CITY:EL MONTESTATE: CAZIP CODE:
91731
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
12/19/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Carol Gregory, Assistant Director TIME COMPLETED:
11:50 AM
NARRATIVE
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At 11:20 am Licensing Program Analyst (LPA) Roxana Lopez conducted an annual continuation visit to El Monte City School District Head Start Office located on 2131 Loma Ave South El Monte, CA 91733. The purpose of this inspection is to review children files as they were not available for review at the Columbia Elementary School facility during the Annual inspection conducted on 12/01/2022. LPA met with Carol Gregory, Assistant Director who provided LPA with the children files for review.

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

LPA issued the Review of Children's Records (LIC 857) to the facility representative during this inspection. The LIC 857 documents the children’s files that were reviewed during this inspection.

LPA did not review staff files during the inspection due to the staff files being stored at the administrative office. LPA will review staff files at a later time and date. If staff files were to be incomplete during the time and date that LPA reviews files, a case management inspection will occur at the facility to reflect the incomplete files.

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.

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.------ pg. 1 of 2 -------

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2022
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: EL MONTE CITY S.D. - COLUMBIA SCHOOL (HEAD START)
FACILITY NUMBER: 198015324
VISIT DATE: 12/19/2022
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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.

Exit interview conducted and report was reviewed with Assistant Director Carol Gregory

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC809 (FAS) - (06/04)
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