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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018287
Report Date: 02/09/2023
Date Signed: 02/09/2023 11:36:53 AM


Document Has Been Signed on 02/09/2023 11:36 AM - 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: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:100CENSUS: 56DATE:
02/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cathy Gaeta TIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced Case Management- Incident inspection. Due to COVID- 19 precautionary measures were taken, appropriate PPE was used. LPA met with Site Supervisor Cathy Gaeta who guided LPA on a tour of the facility. Census was taken.

The purpose of this inspection is to follow up on two separate incidents that were reported to the Department on January 12, 2023 and January 18, 2023. The facility reported these incidents to the Department within the required 24 hours.



Based on information obtained during this inspection, no follow up is necessary regarding the incident reported. The facility followed all proper procedures.

At this time, the facility is in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Site Supervisor Cathy Gaeta and Araceli Brion Education Coordinator----------- pg. 1 of 1 ----------------------

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023
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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