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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597832
Report Date: 09/04/2019
Date Signed: 09/04/2019 01:02:41 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MAOF CHILD CARE CENTER - DOWNEYFACILITY NUMBER:
191597832
ADMINISTRATOR:ARACELY GARCIAFACILITY TYPE:
850
ADDRESS:8100 TELEGRAPH ROADTELEPHONE:
(562) 806-5054
CITY:DOWNEYSTATE: CAZIP CODE:
90240
CAPACITY:80CENSUS: 48DATE:
09/04/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:SupervisorTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Tiffanie Tran arrived at the above facility to conduct a Case Management Incident inspection to follow up on the self-reported incident that occurred at MAOF Child Care Center on 08/01/19. The facility made the 24 hours self-report on 08/01/19. The Monterey Park SW Regional Office received the writing incident report on 08/02/19. Upon arrival, LPA observed proper care and supervision. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.
LPA completed child and staff’s records review. LPA obtained child's document, and personnel report.

Based on interviews conducted, it revealed that on the day of the accident there were two teachers with 8 children. During outdoor play, right after teacher announced clean up, staff observed C1 was helping putting toys away, child was jumping up and down with excitement, she fell and hit her forehead on the corner of the small bench. Child sustained a small laceration on her forehead which required two stitches. Parent contacted in a timely manner. Child missed one day of school. At this time based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision. No deficiency was found.

The content of this report was read and discussed in detail at the time of with the noted contact person.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019
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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