Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016309
Report Date: 06/06/2016
Date Signed 06/06/2016 02:06:29 PM

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:PASITOS HOLLYDALE EARLY HEAD STARTFACILITY NUMBER:
198016309
ADMINISTRATOR:CECILIA VERDUZCOFACILITY TYPE:
850
ADDRESS:12221 INDUSTRIAL AVENUETELEPHONE:
(562) 408-0676
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:16CENSUS: 14DATE:
06/06/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Teacher 11-Josefina PerezTIME COMPLETED:
02:30 PM
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A random site visit was conducted on this date by, Licensing Program Analyst, Katherine Harewood. This site is located on the premises of Human Services Association, a community organization, in the rear of the building. This building services the community which does not open until 6:00 pm and closes at 9:30 pm, Tiger Martial Arts Academy. Day care closes at 3:30 pm. Staff hours are 7:30am-4:30pm.

Furniture and equipment was inspected for age appropriateness and good repair. *** Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with a sink, toilet, and mat/cot was inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. Bathrooms are located inside of the classroom. This suite has two rooms separated by a kitchen area. First Aid supplies were inventoried. Fire drill and child care roster is current.

Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. Food is brought in daily already prepared for consumption.

Outdoor equipment was inspected for safety, cushioning material, good repair and appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water.

Teacher child ratios were observed and staff names (6) recorded. LPA observed a total of 14 children. Most staff is current on infant 1st aid/cpr.
SUPERVISOR'S NAME: Joan HayesTELEPHONE: (323) 981 3381
LICENSING EVALUATOR NAME: Katherine HarewoodTELEPHONE: 323-854-6318
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2016
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PASITOS HOLLYDALE EARLY HEAD START
FACILITY NUMBER: 198016309
VISIT DATE: 06/06/2016
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Children’s Records were reviewed. Staff records will be reviewed at a later date at the main office. If any deficiencies are observed, this report will be amended to reflect deficiency (ies). Staff files are located at HSA Pasitos, 6800 Florence Ave., Bell Gardens, CA 90201



Exit interview conducted. Site visit notice posted. No deficiencies cited at this visit.
SUPERVISOR'S NAME: Joan HayesTELEPHONE: (323) 981 3381
LICENSING EVALUATOR NAME: Katherine HarewoodTELEPHONE: 323-854-6318
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2016
LIC809 (FAS) - (06/04)
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