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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570991
Report Date: 01/12/2024
Date Signed: 01/12/2024 04:17:01 PM

Document Has Been Signed on 01/12/2024 04:17 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:MAOF CHILD CARE CENTER/PICO RIVERAFACILITY NUMBER:
191570991
ADMINISTRATOR:ELIZABETH RAMIREZFACILITY TYPE:
850
ADDRESS:9125 BURKE ST.TELEPHONE:
(562) 949-3189
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 101TOTAL ENROLLED CHILDREN: 80CENSUS: 44DATE:
01/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:EVELYN GUTIERREZ, SITE SUPERVISORTIME COMPLETED:
04:35 PM
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Licensing Program Analysts (LPAs) Roxana Lopez and Jessica Hopkins-Hernandez conducted a case management inspection on this date. LPA met with Site Supervisor Evelyn Gutierrez who guided analyst on a tour of the facility. Census was taken.

LPA conducted today's inspection for the purpose of following up on an incident that was reported to the Department on 11/2/2023. The incident occurred on 10/18/2023 and was not reported to the Department within the 24-hour period. Per Site Supervisor- they reported the incident to the main office on 10/18/2023. LPA advised Site Supervisor that they are able to report incidents themselves and provided incident report email.

Staff and children were interviewed no disclosures were made on this date.

At this time, there is not a preponderance of evidence that shows that the facility was in violation with Title 22 Regulations when the incident occurred. Therefore, there are no deficiencies being cited.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Evelyn Gutierrez Site Supervisor

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2024
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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