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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016244
Report Date: 09/17/2025
Date Signed: 09/17/2025 02:46:10 PM

Document Has Been Signed on 09/17/2025 02:46 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:PLAZA CS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198016244
ADMINISTRATOR/
DIRECTOR:		MARIA PEREZFACILITY TYPE:
850
ADDRESS:4198 UNION PACIFIC AVENUETELEPHONE:
(323) 780-4882
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY: 98TOTAL ENROLLED CHILDREN: 0CENSUS: 30DATE:
09/17/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Maria Villegas Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analysts (LPA) Christine Nolan and Jeanette Estrada conducted an unannounced case management inspection at the facility regarding an incident that was reported to the Department. LPA met with the Site Supervisor, Maria Villegas. LPA explained the reason for the visit. LPA observed 30 children in 4 preschool classroom with three staff in each room.
The facility submitted an Unusual Incident Report (UIR) on 09/10//25 regarding an incident regarding Child 1 washing his hands when he became too weak to stand. Per the UIR, the teacher had to call 911. Child 1's parent was notified and accompanied her child in the medical transport to USC Hospital. During today's visit, LPA conducted staff interviews, observed the area where the incident occurred and collected pertinent documents.
Staff 1 stated she was with Child 1, at the sink, washing his hands, when the incident occurred. Per Staff 1, Child 1 was standing at the sink, when his body began to fall backward. Staff 1 immediately took Child 1 to the classroom next door and called 911. Staff 2, The Site Supervisor, was notified, and arrived in the classroom. Staff 2 contacted Child 1's parent and they arrived within 10 minutes from when the incident occurred. Child 1 was lying on the classroom table, when LAFD arrived and worked on the child. An Ouch report was provided to the LPA. . LPA was later informed by parent 1, that Child 1 will receive follow up medical care, on 09/18.2025.
Per interviews Child 1 returned to school with without any restrictions or doctors note. Per program policy w Child 1 will return on Tuesday 9/18/25 with a doctor's note and a medical care plan.
Based on interviews and record review, the facility responded to the incident by attending to the child and notifying the appropriate parties upon the occurrence of the incident. No deficiencies are cited today.
Exit interview was conducted with Site Supervisor, Maria Villegas. A copy of the report and the Notice of Site Visit was provided.
Karen Chambers
Christine Nolan
DATE: 09/17/0202
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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