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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015613
Report Date: 02/29/2024
Date Signed: 02/29/2024 10:33:33 AM

Document Has Been Signed on 02/29/2024 10:33 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:EL MONTE CITY S.D.-POTRERO SCHOOL HEAD STARTFACILITY NUMBER:
198015613
ADMINISTRATOR:LISA DUNBARFACILITY TYPE:
850
ADDRESS:2611 N. POTRERO AVENUETELEPHONE:
(626) 453-3700
CITY:EL MONTESTATE: CAZIP CODE:
91733
CAPACITY: 20TOTAL ENROLLED CHILDREN: 16CENSUS: 13DATE:
02/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Mario Bonilla, Child Development Instructor TIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced Case Management Incident Inspection to follow up on an incident that was reported to the department on 1/26/2024. A COVID 19 risk assessment was conducted. LPA met with Mario Bonilla, Child Development Instructor who guided LPA on a tour of the facility. Site Supervisor Anzhela Hirscha arrived at 9:45 am and took over the inspection. Census was taken.

On January 26th, 2024, an incident was self reported to the Department via Email by the facility who reported a child had placed playdough up their nostril.



The report was reported within the required 24 hours and written was submitted within the 7 days.

During the inspection, LPA Lopez conducted interviews with staff and child. Incident was observed- child was monitored until they were picked up by parents and taken to the doctor for a check up. While waiting for parents child did sneeze and playdough came out of nose. Child was cleared to come back to school with no restrictions.

At this time, the licensee 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.

Exit interview conducted and report was reviewed with facility representative,Anzhela Hirsch.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/29/2024
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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