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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191592446
Report Date: 05/03/2024
Date Signed: 05/03/2024 08:10:22 PM

Document Has Been Signed on 05/03/2024 08:10 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:MAOF CHILD CARE CTR-FLORENCE-BELL GARDENSFACILITY NUMBER:
191592446
ADMINISTRATOR/
DIRECTOR:		ERNESTINA HERNANDEZFACILITY TYPE:
850
ADDRESS:6431 EAST FLORENCE AVENUETELEPHONE:
(562) 806-3731
CITY:BELL GARDENSSTATE: CAZIP CODE:
90201
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 14DATE:
05/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Rocio Hernandez, Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst Alicia Mooberry made an unannounced Case Management Incident visit at the facility to follow up on incident reported that occurred on 3/18/24 in regard injury sustained by Child #1.
The Monterey Park South West Office received the Unusual Incident Reports via phone on 3/18/24. Upon arrival LPA met with Site Supervisor Rocio Hernandez (S1). Present during the inspection were 14 napping children and 6 staff. Child #1 was observed to be napping in Penguin Room .

Incident reported on 3/18/24 stated that Child # 1 was jumping around cots while other children were napping, S1 grabbed C1's hand to keep C1 from falling. C1 fell then stated her arm hurt. It was determined that child injured arm during fall. C1's Authorized Representative was informed. During this visit LPA interviewed Staff, reviewed Child's file.
Records reveal that Child #1 has had two (2) additional incidents at the facility which resulted in injury to Child 1's arm, reported by the facility on 5/17/23 and 9/21/23. Per facility records and Staff interview, C1 was injured on the same arm. Staff interview state C1 has behavior that disrupts class and other children.

Parent of C1 confirmed that the child has a pre-existing condition and other instances where their arm becomes "dislocated at the elbow and shoulder" and has received medical attention for the issue.

Per Interviews and record review, it was determined that the facility did not take steps to ensure there was a behavior plan for C1 that meets child's physical needs. This poses a potential risk to the health and safety of children in care.



One (1) "B" deficiency is cited in accordance to California Code of Regulations Title 22.

Notice of site visit was provided and Site Supervisor was reminded it must remain posted for 30 days.
Exit interview conducted and a copy of the report was provided to Site Supervisor, Rocio Hernandez. Appeal Rights were discussed.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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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Document Has Been Signed on 05/03/2024 08:10 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 05/03/2024 at 03:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MAOF CHILD CARE CTR-FLORENCE-BELL GARDENS
FACILITY NUMBER: 191592446

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2024
Section Cited
CCR
101229(a)

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The licensee shall provide care and supervision as necessary to meet the children's needs.

This requirment was not met as

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Per Site Supervisor, teachers and staff will continue to received training on behavior management, and avoid holding C1's hand or arm. A written plan of care will provided to LPA by POC due date
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Based on interview and record review, C1 has been injured on th same are on three separte ocassions.
his posed a potential risk to the health and safety of children in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024


LIC809 (FAS) - (06/04)
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