<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570991
Report Date: 11/06/2019
Date Signed: 11/06/2019 01:57:51 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:MAOF CHILD CARE CENTER/PICO RIVERAFACILITY NUMBER:
191570991
ADMINISTRATOR:ELIZABETH RAMIREZFACILITY TYPE:
850
ADDRESS:9125 BURKE ST.TELEPHONE:
(562) 949-3189
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:117CENSUS: 99DATE:
11/06/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Evelyn GutierrezTIME COMPLETED:
02:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Case management inspection conducted by Licensing Program Analysts Jennifer Hua and Jose Guzman. LPAs met with teacher in charge Evelyn. LPA toured the facility with Ms. Evelyn Gutierrez. Director is not present during this visit. The purpose of this inspection is to obtain additional information regarding the incident that occurred on 10/17/19. A child was left unattended on the playground when staff and other children transitioned from outside to inside. Staff were not aware that child was left outside until the parent came to pick up child. Interviews were conducted with staff. Information received confirmed that child was left unattended outside.

Based on information received, deficiency is cited on attached 809D. An exit interview conducted with Evelyn Gutierrez, lead teacher.
.
Upon receipt of this report documenting a substantiated complaint allegation and a Type A deficiency, the licensee shall do the following:

1. Post the Notice of Site visit and any licensing report documenting a Type “A” deficiency.
2. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.
3. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).
4. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this visit.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: MAOF CHILD CARE CENTER/PICO RIVERA
FACILITY NUMBER: 191570991
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2019
Section Cited

1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by: A child was left unattended outside, staff were not aware until
8
9
10
11
12
13
14
parent came to pick up child. At that time, staff went to the playground area where child was found. This poses an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2