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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364815787
Report Date: 03/03/2021
Date Signed: 03/04/2021 10:15:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MEXICAN AMER. OPPORTUNITY FOUND. FREMONT PRESCH.FACILITY NUMBER:
364815787
ADMINISTRATOR:SUSAN GARCIAFACILITY TYPE:
850
ADDRESS:9950 FREMONT AVENUETELEPHONE:
9096261092
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:72CENSUS: 0DATE:
03/03/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Susana GarciaTIME COMPLETED:
05:30 PM
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On date and time listed, Licensing Program Analyst (LPA) Nelson Zuniga conducted a tele-investigation (Telephone call) with the Licensee, due to COVID-19 and CA Department of Public Health guidelines of social distancing.

This tele-inspection is being conducted to follow up on an Unusual Incident Report that was submitted on 02/17/2021.



The report stated that there is a possible personal rights violation.

LPA Zuniga requested additional information from director.
Further investigating is needed to complete this investigation.
This tele-inspection was conducted on 03/03/2021. This report was emailed to licensee on 03/04/2021.

An exit interview was conducted. A copy of this report is being emailed to Licensee. A read receipt from the email sent to Licensee will be in lieu of the signature for this tele-investigation.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021
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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