191592324-3-6-2024-54-CC-DGIS-D3BTCW-20240313143723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592324
Report Date: 03/06/2024
Date Signed: 03/06/2024 05:22:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/22/2023 and conducted by Evaluator Tiffanie Tran

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20231222091507

FACILITY NAME:	MAOF CHILD CARE CENTER MAYWOOD		FACILITY NUMBER:	191592324
ADMINISTRATOR:	ROCIO HERNANDEZ		FACILITY TYPE:	850
ADDRESS:	6145 WOODWARD AVENUE		TELEPHONE:	(323) 562-0490
CITY:	MAYWOOD	STATE: CA	ZIP CODE:	90270
CAPACITY:	40	CENSUS: 7	DATE:	03/06/2024
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Emestina Hernandez		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Personal Rights- Daycare child sustained a severe head injury while in care and the staff did not seek medical attention in a timley manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), T. Tran arrived at the above licensed facility to conduct a subsequent complaint inspection for the purpose of concluding for the aforementioned allegations. LPA met with Emestina Hernandez, Site Supervisor. LPA observed proper care and supervision.
During today’s visit, LPA completed staff and children's files review. Child’s document obtained for the record. During the course of the investigation, LPA completed record review and interviews conducted with staff, children, and other. Record indicated the facility had self-reported the above incident to Monterey Park Southwest Office on 11/28/23 in a timely manner. Per staff, the incident happened on 11/28/23 did not triggered a 911 call. Parent was contact immediately and child was taken to children's hospital for checkup. Per doctor’s note, child was fine, no treatment needed. Due to insufficient evidence to support or disprove child’s personal rights has been violated while in care, therefore this allegation has been determined unsubstantiated. Unsubstantiated – A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the facility representative, Emestina Hernandez

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie Tran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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