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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017723
Report Date: 10/21/2025
Date Signed: 10/21/2025 01:06:02 PM

Document Has Been Signed on 10/21/2025 01:06 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:MIRAMONTE HEAD START/STATE PRESCHOOL AGENCYFACILITY NUMBER:
198017723
ADMINISTRATOR/
DIRECTOR:		GONZALES, ALMAFACILITY TYPE:
850
ADDRESS:10620 SCHMIDT RDTELEPHONE:
(626) 652-4250
CITY:S. EL MONTESTATE: CAZIP CODE:
91733
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
10/21/2025
TYPE OF VISIT:Case Management - Annual ContinuationANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Samara BakerTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an announced annual continuation inspection to the Mountain View School District Head Start located at 2109 Burkett Rd, El Monte, CA 91732 on 10/21/25 at 08:35 am. The purpose of this inspection is to review staff and children's files as they were not available for review at Miramonte Head Start/State Preschool facility during the Annual/Random inspection conducted on 10/14/25. LPA met with Samara Baker program manager who provided LPA with staff and children's files for review.

LPA reviewed staff 1 (S1s) file and observed it to be complete. LPA also reviewed 5 random children’s files, and all files were observed to be complete. According to the program manager, S2 is hired with the School District and is only an as needed substitute. Due to being an employee with the School District, program manager stated that employees are not required to submit proof of immunizations (MMR, Tdap, Flu vaccine or declination letter); however, the program manager received a copy of S2s TB test and a copy of the Mandated Reporter Training AB 1432/1913 which is required for all district employees. LPA cannot determine if S2s Mandated Reporter Training AB 1432/1913 meets the requirement for the Mandated Reporter Training AB1207. LPA requested that the facility submits a description of the Mandated Reporter Training AB 1432/1913 for review. Though S2 is an as needed substitute, the facility is still required to have available all required forms/documents. LPA also discussed with the program manager that child care centers should have available for review the required forms/documents listed on LIC 311A. LPA also provided Technical assistance for missing proof of immunizations, Mandated Reporter Training AB 1207, and personnel records.

LPA discussed with the program manager that staff and children's files must be available for review at the child care center during an inspection.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2025
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: MIRAMONTE HEAD START/STATE PRESCHOOL AGENCY
FACILITY NUMBER: 198017723
VISIT DATE: 10/21/2025
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LPA also provided information regarding a possible waiver request for staff and children's files to be available for review offsite at the Mountain View School District Head Start Office.

LPA issued the Review of Staff/Volunteers Records (LIC 859) and Children's Records Review (LIC 857) to the program manager during this inspection which documents files that were reviewed during this inspection.

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 was conducted, and a copy of this report was provided to program manager Samara Baker.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC809 (FAS) - (06/04)
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