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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014197
Report Date: 11/01/2024
Date Signed: 11/01/2024 02:57:12 PM

Document Has Been Signed on 11/01/2024 02:57 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CHILDREN'S BUREAU FAMILY CENTER AT MAGNOLIA PLACEFACILITY NUMBER:
198014197
ADMINISTRATOR/
DIRECTOR:		MARY HELEN VASQUEZFACILITY TYPE:
850
ADDRESS:1910 MAGNOLIA AVENUETELEPHONE:
(213) 342-0101
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: 13DATE:
11/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Paquita MansouriTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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On 11/1/2024, at 2:20 p.m., Licensing Program Analysts (LPAs) Claudia Kam and Joshua Ortega conducted an unannounced case management inspection and met with director Paquita Mansouri. LPAs disclosed the purpose of the inspection and was granted entry into the facility by director.

Census was taken there were 13 children and 3 staff present during the inspection.

The purpose of today's inspection was to discuss clearance of plan of correction for deficiencies assessed on 7/26/24, for absence of carbon monoxide detector, and expired mandated reporter.
At 2:20 p.m. LPAs observed and tested carbon monoxide detector which is installed in the hallway. LPAs reviewed files and observed current mandated reporter for staff.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 11/1/24.

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



Exit interview conducted and report was reviewed with director Paquita Mansouri.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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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