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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001351
Report Date: 05/10/2023
Date Signed: 05/10/2023 01:33:01 PM

Document Has Been Signed on 05/10/2023 01:33 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:92ND & MAIE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198001351
ADMINISTRATOR:ALICIA GARCIAFACILITY TYPE:
850
ADDRESS:9200 MAIE AVE.TELEPHONE:
(323) 249-0621
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: DATE:
05/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Marissa DominguezTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPAs) Franchesca White and Katrina Chicote conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 05/08/2023. Upon arrival, LPA met with Marissa Dominguez, who provided LPAs a tour of the facility inside and outside.

On 05/08/2023, an incident was self-reported to the Department where a parent made an allegation that their child's personal rights were violated while in care to the Director. The facility reported this incident to the Department within the required 24 hours. During this inspection, LPA interviewed children and staff at facility. Staff members provided log sheets with recent documentation of Child 1 (C1) behaviors. Staff members shared their experience with C1, and how they attempt to manage his behaviors. LPA interviewed C1 by asking qualifying questions, and he answered them, but he was unable to answer any open-ended questions regarding the incident. C1 has limited speech and requires help expressing himself. LPA interviewed C2 and when asked about how he is cared for when he has a bad day he said, "Teacher Lorena gives me time to calm down, or she asks me am I ok. I tell her yeah!"

Site Supervisor stated that facility is communicating with the parent to find new ways to manage child's behavior. Site Supervisor will be providing trainings to staff in regards to the Parent Handbook regulations on "The Process and Strategies used to support the behavior management policy". LPA obtained documentation available at time of inspection.

Based on the information obtained and LPA observation, LPA determined there will be no deficiencies cited at this time, per California Code of Regulations Title 22, Division 12.

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.

Exit interview conducted and report reviewed with, Marissa Dominguez. Report Ends - Page 1 of 1
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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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