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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001022
Report Date: 12/23/2024
Date Signed: 12/23/2024 01:01:49 PM

Document Has Been Signed on 12/23/2024 01:01 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MAOF CHILD CARE CENTER-FORDFACILITY NUMBER:
198001022
ADMINISTRATOR/
DIRECTOR:
NORMA FIGUEROAFACILITY TYPE:
850
ADDRESS:330 SOUTH FORD BLVD.TELEPHONE:
(323) 264-4333
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 31DATE:
12/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Nora LopezTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Case Management Incident inspection at the above facility on 12/23/24 at 10:25 a.m. The purpose of this inspection is to follow up on an incident reported to the Department on 12/18/24. LPA met with site supervisor, Nora Lopez who guided LPA on a tour of the facility. Census was taken.

On 12/13/24 at approximately 10:30 a.m. Child #1 (C1) was in the bike track of the playground using a tricycle when C1 fell on the left side of the arm hitting the cement. According to Staff 1 (S1), they were nearby supervising children in the playground. Per S1, S2 was also present supervising the playground from a different angle. S1 stated that C1 was alone riding a tricycle on the bike track. C1 was not going fast when C1 made a turn lost their balance causing them to fall on the cement. S1 denies that there were any objects on the bike track that may have caused C1 to fall from the tricycle. S1 also stated that there were no other children on the bike track as C1 was alone. S1 lifted the jacket of C1 to assess the area; however, there were no visual injuries. S1 provided first aid and placed an ice pack on C1 arm. According to S1, C1 did not have any bruising, scratches, or swelling on the arm. S1 also recalls C1 asked if they could continue playing. Per S1, C1 did not complain of any pain throughout the day. According to S1, they left early on that day; however, S2 and S3 disclosed that C1 had lunch, a nap, snacks and did not complain of any pain until pick up. During pick up, parent was informed that C1 had fallen off the tricycle hitting the left side of the arm. An incident report was provided to the parent. According to S1, parent stated that C1 would be taken to the doctor. S1 followed up with parent on 12/16/24 where it was disclosed that C1 sustained a fracture and was given a sling. C1 returned to the facility on 12/23/24 with a cast and currently has restrictions of no physical activity until 01/11/25. LPA interviewed C1 who stated that they were on the tricycle when they fell and recalls seeing S2. C1 did not provide additional information regarding the incident. According to S1, there has never been an accident on the bike track in the last 12 years. The incident happened so fast that it couldn't have been prevented. LPA took pictures of the tricycles and bike tack. LPA observed that the tricycles are age appropriate and did not observe any hazards on the track.

During this inspection, LPA interviewed Staff 1 (S1) and Child 1 (C1).



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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MAOF CHILD CARE CENTER-FORD
FACILITY NUMBER: 198001022
VISIT DATE: 12/23/2024
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At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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, a civil penalty of $100 can be assessed.

Exit Interview was conducted, and appeal rights were given, along with a copy of this report was provided to site supervisor Nora Lopez.





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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC809 (FAS) - (06/04)
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