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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001022
Report Date: 11/01/2023
Date Signed: 11/01/2023 03:54:12 PM


Document Has Been Signed on 11/01/2023 03:54 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:MAOF CHILD CARE CENTER-FORDFACILITY NUMBER:
198001022
ADMINISTRATOR:NORMA FIGUEROAFACILITY TYPE:
850
ADDRESS:330 SOUTH FORD BLVD.TELEPHONE:
(323) 264-4333
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY:72CENSUS: 18DATE:
11/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Nora Lopez, Site SupervisorTIME COMPLETED:
03:55 PM
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On November 1, 2023, Licensing Program Analysts (LPAs), Monique Ayala and Staicy Perry conducted an unannounced case management inspection. The purpose of the inspection is to follow up on an incident reports that filed on 10/13/2023 and were reported to the department in a timely manner. A COVID-19 risk assessment was conducted prior to entering the facility. LPAs met with Site Director, Nora Lopez who guided LPAs on a tour of the facility. LPAs observed 18 children in care with 11 staff members.

Brief summary of incident : October 13, 2023, mother of Child #1 (C1) reported to site supervisor that she wanted C1 to transfer to another class and claimed that Staff #1 (S1) grabs C1's arm and does not give C1 water.

During this inspection LPAs interviewed Child #1. LPAs interviewed Staff #2 (S2) and Staff #3 (S3), S1 was not present at the facility and LPAs were unable to interview. LPAs obtained a copy of the facility roster and S#1 contact information.

At this time the incident report requires further investigation. There will be no deficiencies cited today, 11/01/2023.

An exit interview was conducted and a copy of this report was provided to the principal, along with Notice of Site Visit. Notice of Site Visit must be posted for 30 days.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023
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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