198018769-10-2-2025-33-CC-RLOZ-DM3RLQ-20251002130731

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018769
Report Date: 10/02/2025
Date Signed: 10/02/2025 01:07:40 PM

Document Has Been Signed on 10/02/2025 01:07 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	PLAZA DE LA RAZA C.D.S.- MAIZELAND		FACILITY NUMBER:	198018769
ADMINISTRATOR/ DIRECTOR:	CABOT, NORAYMA		FACILITY TYPE:	830
ADDRESS:	7601 CORD AVE.		TELEPHONE:	(562) 205-2789
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY: 96	TOTAL ENROLLED CHILDREN: 80	CENSUS: 52	DATE:	10/02/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:45 AM
MET WITH:	Patty Arrua, Site Supervisor		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced Case Management inspection due to two incidents that were reported to the Department. LPA met with Site Supervisor Patty Arrua who guided LPA on a tour of the facility. Census was taken.

On June 4th, 2025, an incident was self reported to the Department via Email by the facility who reported that child # 1 jumped off a chair outside landing on their elbow.

On September 25th ,2025 an incident was self reported to the Department via Email by the facility who reported that on September 24th, 2025 child # 2 was running tripped and fell hitting their forehead on a the wooden part of a children's couch. Reports were reported within the required 24 hours. The purpose of the inspection was to obtain additional information regarding the incident reported to the Department. During the inspection, LPA Lopez conducted interviews with Site Director and staff.

Regarding the incident reported on June 4th, 2025- interviews corroborated that incident was observed- during outdoor time child # 1 was playing on the colorful block chairs- child climbed and jumped off the chair landing on elbow. Ice pack was applied and parents were called. Parents took child to the doctor- it was determined that child had a fracture elbow. Child returned to school with restrictions. Staff continue to remind children of the rules and appropriate use of furniture.

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Roxana Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
MONTEREY PARK CC RO, 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: 10/02/2025

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Regarding the incident reported on September 25th,2025- interviews corroborated that after hand washing child # 2 threw their paper towel away in the trash can and ran towards the couch- child tripped and fell forward hitting their forehead on the wooden part of the couch. Incident was observed- ice pack was provided and parents were called. Parents took child to the doctor for precautions- child had no injury and came back the next day with no restrictions.

LPA inspected the classroom and outdoor area of the incidents. LPA did not observe any hazards; LPA advise that reminders of using walking feet, using furniture appropriately and staff moving with the children is best practice.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative, a civil penalty of $100 can be assessed.

Exit interview conducted and report was reviewed with site supervisor Patty Arrua.

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Roxana Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC809 (FAS) - (06/04)

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