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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018225
Report Date: 03/20/2026
Date Signed: 03/20/2026 01:34:55 PM

Document Has Been Signed on 03/20/2026 01:34 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: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: 44CENSUS: 33DATE:
03/20/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Site Supervisor, Jazmin LealTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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On March 20, 2026, Licensing Program Analysts (LPA) Priscilla Ochoa conducted an unannounced case management inspection for the above facility. LPA was greeted by the Site Supervisor, Jazmin Leal, who guided LPA on a tour of the facility. The purpose of this inspection is to follow up on a self-reported incident that occurred at the facility on 03/09/2026. This is a preschool program that operates Monday through Friday from 7:45 am to 4:15 pm. Per Site Supervisor, there are 44 children enrolled, and LPA observed 33 children in care along with 7 staff members.

Brief summary of incident: Child #1 (C1) was running on the large play ground and tripped on the uneven pavement. C1 hit the left side of their forehead above left eyebrow on a tricycle handlebar.

During this investigation, LPA interviewed Staff 1 (S1) – Staff 3 (S3), partially interviewed C1(C1), observed the pavement area where the incident occurred, reviewed a picture of C1’s injury, reviewed C1 doctor’s note and incident report that was documented and signed by the parent.

Based on interviews, a staff member did not observe the incident occurre. Per S1, S2 and S3 were both on the playground at the time of the incident. Per S3, they were closest to the area where the incident occurred. S3 was positioned in the middle of the doorway between the playground and the restroom as they had taken a child to the restroom and waiting for them to finish. Per S3 their body was still positioned, where they can provide supervision on the playground. S1 and S3 disclosed that the playground is divided into zoning areas to ensure children are supervised.

At the time of the incident there were 12 children on the playground and 2 teachers. LPA asked S3 what is the protocol when a staff member takes a child to the restroom when on the playground?

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2026
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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Document Has Been Signed on 03/20/2026 01:34 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 03/20/2026 at 12:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PARA LOS NINOS HEAD START - HOLLYWOOD
FACILITY NUMBER: 198018225

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2026
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision
No child(ren) shall be left without the supervision of a teacher at any time…Supervision shall include visual observation.

This requirement is not met as evidenced by:
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Per site supervisor, the facility will watch Supervising children in childcare centers video that is available on the department website. Site supervisor will provide a staff sign in sheet acknowledging the participation of the staff members and a brief statement from the teachers about
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Based on the LPA’s interviews conducted the facility did not comply with section above as there was no staff member on the playground that witness C1 fall and hit their left side of their forehead hit a tricycle handle bar, causing a bump on their left side of the forehead.
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what they learned from the video and what can be done different at the facility to ensure 100% supervision by POC date of 4/03/2026.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Priscilla Ochoa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2026


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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PARA LOS NINOS HEAD START - HOLLYWOOD
FACILITY NUMBER: 198018225
VISIT DATE: 03/20/2026
NARRATIVE
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S3 states that they communicate with the other teacher that they are taking a child to the restroom and the other staff member is supposed to move their body to a middle area where they have a visual of the full yard. S3 acknowledges that they did communicate with S2 that they were going to take a child to the restroom and witnessed S2 move their body to a middle area granting them a better view of the playground. S3 also confirms that they also had a view of the blind spots. However, S3 mentioned they turned their head to face the restroom to see if the child in the restroom was finished. At the moment S3 did not have a view of the playground, which is when C1 approached S3 to inform them that they had fallen and hurt their head. Per S3, C1 mentioned that their body wobbled and fell. C1 re-enacted what occurred to S3, which C1 was running towards the tricycle area and felt their body wobble and fell. C1’s left side of their forehead hit a tricycle handle bar, causing a bump on their left side of the forehead. S2 could not confirm nor deny the incident as they do not recall what occurred. LPA attempted to interview C1, however, during the interview C1 stated that they did not want to talk anymore and wanted to go back to class.

C1 did sustain a minor head injury to the left side of their forehead causing a red mark. C1 was given an ice pack and continued their day with no pain or concern. The child did not need any medical attention, however per the facilities policy, when a child endures a head injury the parent is required to take the child to seek medical attention and provide a doctor’s note clearing the child to return to school. C1 returned to the facility the next day on 3/10/2026 with no restrictions.

S1 mentioned after the incident occurred, they went to inspect the area where C1 fell and noticed that the pavement was uneven. Per S1, on Tuesday 03/17/26, the facilities maintenance team came and sanded the uneven area to ensure that the pavement is as smooth as possible to avoid any further incidents.

Based on the LPA’s observations and record review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

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

Exit interview conducted and report was reviewed with the Site Supervisor, Jazmin Leal.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC809 (FAS) - (06/04)
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