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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018769
Report Date: 08/31/2023
Date Signed: 08/31/2023 04:12:59 PM

Document Has Been Signed on 08/31/2023 04:12 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: 79CENSUS: 60DATE:
08/31/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Director Cathy GaetaTIME COMPLETED:
03:30 PM
NARRATIVE
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At 1:20 pm Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced case management- deficiencies inspection to the above facility. A Covid risk assessment was conducted upon entry. LPA met with Cathy Gaeta, Director, who guided analyst on a tour of the facility. The purpose of this inspection to follow up on incident and provide findings to a self reported incident which was reported on 8/2/2023.

Incident self reported stated that Staff # 1 witnessed Staff # 2 dragged a cot across the room while child #1 was laying on the cot.

LPA interviewed Director Patty Arrua and both staff regarding incident. All 3 staff corroborated that incident did occur, cot was "moved" across the room by staff # 3 while child was on it. Director, stated that incident was recorded.

LPA did view recording of incident. LPA observed 3 staff in the classroom- one staff was helping a child sleep, second one was sitting down on a couch working on paperwork and third one was cleaning up after lunch. LPA observed child # 1 playing on their cot and grabbing items from a shelve. Staff cleaning went up to child #1, three different times putting items back on shelf and went back to cleaning, as child continued staff went back to child, grabbed the cot by the legs as child was laying on it and dragged cot over to the middle of the room. Video recording did not have any audio- LPA was unable to hear if there was any communication between staff and child. Once in the classroom LPA measured the distance of where the cot was located at to where it was moved to- distance was approximately 7 feet.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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: PLAZA DE LA RAZA C.D.S.- MAIZELAND
FACILITY NUMBER: 198018769
VISIT DATE: 08/31/2023
NARRATIVE
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Per Director, the policy to move a child and a cot is to have child come off the cot, move the cot and then have child lay down again. Staff # 3 disclosed that since child was not sleeping in that area they grabbed cot with child laying on it and "glide it" across the room. Per staff # 3 they were talking to child at all times. Staff # 3 stated that from their understanding what they should have done is asked child to move from cot before moving cot.

Based on LPA, observations and interviews, the following deficiency listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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 Representatives Cathy Gaeta and Gloria Mejia.



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

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/31/2023 04:12 PM - It Cannot Be Edited


Created By: Roxana Lopez On 08/31/2023 at 03:03 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PLAZA DE LA RAZA C.D.S.- MAIZELAND
FACILITY NUMBER: 198018769

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2023
Section Cited
CCR
101223(a)(3)

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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights:To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions... This requirement is not me at
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Per Director- they will condut a training regarding personal rights and napping policy. Meeting notes and sign in sheet will be submitted to LPA. Additionally, a decleration written by Staff # 3 of what happened and what they've learned from taining should also be submitted to LPA by 9/22/2023
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evidenced by : Based on observation and interviews the licensee did not comply with the directive above, as that Staff # 3 dragged a cot with child laying on it approx 7 feet because child was not sleeping. This poses a potential health and safety risk to 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023


LIC809 (FAS) - (06/04)
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