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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018769
Report Date: 08/22/2023
Date Signed: 08/22/2023 05:06:12 PM

Document Has Been Signed on 08/22/2023 05:06 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:PLAZA DE LA RAZA C.D.S.- MAIZELANDFACILITY NUMBER:
198018769
ADMINISTRATOR:CABOT, NORAYMAFACILITY TYPE:
830
ADDRESS:7601 CORD AVE.TELEPHONE:
(562) 205-2789
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 0DATE:
08/22/2023
TYPE OF VISIT:CollateralANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Human Resources Director, Ruben SimentalTIME COMPLETED:
04:00 PM
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At 3:00 pm Licensing Program Analysts (LPAs) Roxana Lopez and Lilli Babcock conducted a Collateral Visit 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 a video recorded of an incident self reported to the department on 8/3/2023.

LPA's reviewed the video of incident, notes were taken. Findings of incidents will be provided on a follow up visit to the main facility.

At this time, the licensee 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 the facility representative Human Resources Director Ruben Simental.

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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