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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018225
Report Date: 04/23/2024
Date Signed: 04/23/2024 11:00:49 AM

Document Has Been Signed on 04/23/2024 11:00 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:PARA LOS NINOS HEAD START - HOLLYWOODFACILITY NUMBER:
198018225
ADMINISTRATOR/
DIRECTOR:
ANGELA CAPONEFACILITY TYPE:
850
ADDRESS:5000 HOLLYWOOD BLVDTELEPHONE:
(213) 250-4800
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 33DATE:
04/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Vanessa Quezada, Area SupervisorTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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On April 23, 2024, Licensing Program Analysts (LPAs) Monique Ayala and Priscilla Ochoa conducted an unannounced case management inspection at the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. The purpose of this inspection is to follow up on an unusual incident report that occurred on 04/05/2024 and was filed with our department on 04/08/2024. LPA met with Area Supervisor, Vanessa Quezada. LPAs observed 33 children in care with 8 staff.

Brief Summary of Incident: On 04/05/2024 at approximately 2:50PM, while playing outside Child #1 (C1) was running and tripped on his foot. C1 placed his right arm up to prevent his face from hitting the floor. C1 right arm ended up under his body resulting C1 hurting his arm. C1 was provided first aid. The facility called 911 and it was recommended to take C1 to the emergency room. C1 was given a splint for his right arm.

During this investigation, LPAs interviewed, staff #1 (S1), staff #2 (S2), staff #3 (S3) and obtained a copy of incident report. LPAs was unable to interview C1, as C1 has not returned to the facility. LPAs interviewed Child #2 (C2) who stated C1 fell and hurt his arm and went to the hospital. C2 stated S1 was with C1 when the incident occurred. S1-S3 stated that there 13 children in the small yard with 3 staff members. S1 stated she observed the incident occur and was able to provide care for C1 immediately.

There are no deficiencies being cited at this time.

An exit interview was conducted a copy of this report along with Notice of Site Visit was provided to Area Supervisor, Vanessa Quezada. Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
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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