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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014619
Report Date: 08/22/2023
Date Signed: 08/22/2023 05:07:55 PM

Document Has Been Signed on 08/22/2023 05:07 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PIO PICO CENTERFACILITY NUMBER:
198014619
ADMINISTRATOR:CHRISTINA V. CONTRERASFACILITY TYPE:
850
ADDRESS:4211 S. COLUMBIATELEPHONE:
(562) 205-1251
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
08/22/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Human Resources Director, Ruben Simental TIME COMPLETED:
04:30 PM
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At 4:00 pm Licensing Program Analysts (LPAs) Roxana Lopez and Lilli Babcock conducted a Case Management- Annual continuation to Plaza de La Raza Headquaters located at 13300 Crossroads Pkwy N City of Industry, CA 91746. LPA's met with Human Resources Director, Ruben Simental. The purpose of this inspection is to review staff files as they were not available for review at the Pio Pico facility during the Annual inspection conducted on 1/4/23.

Staff Records were reviewed for completeness: Inspections of required forms was made.



LPA issued the Review of Staff' Records (LIC 859) to the facility representative during this inspection. The LIC 859 documents the staff files that were reviewed during this inspection.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided.
Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov.

For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.----------- pg. 1 of 2 ---------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PIO PICO CENTER
FACILITY NUMBER: 198014619
VISIT DATE: 08/22/2023
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At this time, the facility is in compliance with California Code of Regulations Title 22. No deficiencies cited.
A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Facility Representative Human Resources Director Ruben Simental.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC809 (FAS) - (06/04)
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