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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001351
Report Date: 12/03/2021
Date Signed: 12/03/2021 01:29:10 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:92ND & MAIE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198001351
ADMINISTRATOR:RAYMOND HERNANDEZFACILITY TYPE:
850
ADDRESS:9200 MAIE AVE.TELEPHONE:
(323) 249-0621
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY:54CENSUS: 16DATE:
12/03/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Cassandra Gallaro, Lead Toddler Teacher (S1)TIME COMPLETED:
02:15 PM
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On 12/03/2021, Licensing Program Analyst (LPA) Katrina Chicote conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 11/09/2021. Upon arrival, LPA met with Cassandra Gallardo, Lead Toddler Teacher (S1), who provided LPA a tour of the facility inside and outside. Census was taken.

On 11/09/2021, an incident was reported to the department where a child bit a staff member. The facility reported this incident to the Department within the required 24 hours. During this inspection LPA interviewed staff who observed incident, which was S1. LPA obtained and reviewed documentation. S1 states that child was having a difficult time that day and has no verbal skills and has a tendency to act out physically, this time the child acted out and bit a staff member. After incident, parent was called and picked up child. S1 states they work closely with Child 360 resources, who already has observed the child at the facility and are currently working with the family for a behavioral therapy plan. Staff that was bit did not have open wound but had a severe bruise in the shape of a bite mark.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit on 12/03/2021.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and report was reviewed with the Facility Representative, Cassandra Gallardo.
Report Ends - Page 1 of 1
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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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