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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001351
Report Date: 08/10/2023
Date Signed: 08/10/2023 12:15:10 PM

Document Has Been Signed on 08/10/2023 12:15 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 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: 33DATE:
08/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:23 AM
MET WITH:Marissa DominguezTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced case management inspection. LPA LPA met with Site Supervisor Marissa Dominguez who provided assistance. The purpose of today's inspection is to provide measuring for a toddler class that the facility intends on using for the preschool.

As a courtesy, LPA conducted measurements of the middle toddler classroom minus encumbered space. Based on LPAs measurement the classroom may be able to accommodate 15 preschool children.

NOTE: LPA informed Site Supervisor that today's inspection is an assumption based on current observations. It is possible that the room capacity numbers may change (up or down) depending on how classrooms are rearranged. In addition, any capacity information from the fire clearance may supersede measurements. For example, if the fire clearance is for 54 then the school may have to accommodate the fire department's capacity (unless the fire department conducts a more recent assessment).

LPA informed Site Supervisor Dominguez to submit an application with a letter indicating her request of the changes she intends to implement.

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 was conducted with Site Supervisor Marissa Dominguez.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
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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