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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018769
Report Date: 08/10/2023
Date Signed: 08/10/2023 04:56:59 PM


Document Has Been Signed on 08/10/2023 04:56 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:PLAZA DE LA RAZA C.D.S.- MAIZELANDFACILITY NUMBER:
198018769
ADMINISTRATOR:CABOT, NORAYMAFACILITY TYPE:
830
ADDRESS:7601 CORD AVE.TELEPHONE:
(562) 205-2789
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:96CENSUS: 8DATE:
08/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Supervisor Patty Arrua TIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced Case Management inspection due to an incident that were reported to the Department on August 1st, 2023. A COVID risk assessment was conducted upon entry. LPA met with Supervisor Patty Arrua, who guided LPA on a tour of the facility. Census was taken.


On August 1st, 2023 one incident was self reported to the Department via Email by the facility who reported a witness alleges that a child's personal rights were violated while in care.

The purpose of the inspection was to obtain additional information regarding the incident reported to the Department.

During the inspection, LPA Lopez conducted interviews with Supervisor and 1 staff. LPA was unable to complete interviews on this date. Due to additional staff/children were not available for interview at this time, a follow up visit will be required at a later date in order to conduct further interviews and/or obtain additional documentation.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Patty Arrua.



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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023
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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