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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015613
Report Date: 08/28/2024
Date Signed: 08/28/2024 11:48:31 AM

Document Has Been Signed on 08/28/2024 11:48 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/
DIRECTOR:
LISA DUNBARFACILITY TYPE:
850
ADDRESS:2611 N. POTRERO AVENUETELEPHONE:
(626) 453-3700
CITY:EL MONTESTATE: CAZIP CODE:
91733
CAPACITY: 20TOTAL ENROLLED CHILDREN: 16CENSUS: 15DATE:
08/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Site Supervisor Elsa Gomez TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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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 05/24/24. An attempted visit was conducted on 8/16/2024. LPA met with Elsa Gomez, Child Development Site Supervisor who guided LPA on a tour of the facility. Census was taken.

On May 24th, 2024, an incident was self reported to the Department via Email by the facility who reported that on May 23rd, 2024 a parent disclosed that child's # 1 was inappropriately touch by child # 2. 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 children. Documentation was obtained.

Incident requires further investigation- No deficiencies cited on this date.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representatives, Elsa Gomez and Queta Morales.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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