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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018287
Report Date: 10/05/2021
Date Signed: 10/05/2021 02:14:59 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: 41DATE:
10/05/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH: Gloria Mejia, Assistant Director of EducationTIME COMPLETED:
02:29 PM
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At 11:31AM an unannounced Case Management-Incident inspection was conducted by Licensing Program Analysts (LPAs) Lissete Gonzalez and Lilli Babcock to follow up on an Unusual Incident. Upon arrival, LPAs met with Assistant Director of Education, Gloria Mejia and Education Coordinator, Araceli Brion. Census was taken.

The incident that occurred on 09/23/21 was reported to the Department on 09/24/21 via a written report emailed to Community Care Licensing. The facility reported the incident in a timely manner.

The Unusual Incident reported concerns of a possible violation of the Personal Rights of children in care by Staff #3 in Room #10. During today's inspection, LPAs obtained documentation including the children’s roster and interviews were conducted with staff and witnesses. Due to insufficient information available at this time, the above allegation needs further investigation.

Exit interview conducted with Assistant Director of Education, Gloria Mejia.

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.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
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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