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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018287
Report Date: 10/25/2019
Date Signed: 10/25/2019 12:30:30 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PLAZA DE LA RAZA - MAIZELANDFACILITY NUMBER:
198018287
ADMINISTRATOR:NNEKA ARINZEFACILITY TYPE:
850
ADDRESS:7601 CORD AVE.TELEPHONE:
(562) 205-2789
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:80CENSUS: 25DATE:
10/25/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Patricia FierroTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Lissete Gonzalez conducted a case management inspection due to an incident that occurred on 10/07/2019. Upon arrival, LPA met with Early Head Start Teacher, Yoselin Arancibia, who guided LPA on a tour of the facility. At approximately 9:33a.m., Site Supervisor, Patricia Fierro, arrived to complete the inspection. Also present was Director, Nneka Arinze. Census was taken.

The incident that occurred on 10/07/19 was received by the Department on 10/08/19 via fax. The facility reported the incident to the Department within the required 24 hours. LPA conducted interviews and obtained documentation during this visit.

It was reported to the Department that Child #1 bit Staff #1. During interviews with Staff #1, Staff #2, Staff #3, and Staff #4 it was disclosed the Child #1 is receiving various services to address behavioral concerns and services are being provided to support facility staff. In addition, Staff #1 did not require any medical attention.

Based on all information obtained on this date, record review, and interviews conducted, LPA determined there was adequate supervision provided the day of the incident. Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit.

Exit interview was conducted with Site Supervisor, Patricia Murillo. Appeal rights explained & provided.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 day 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.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
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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