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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364815787
Report Date: 08/13/2021
Date Signed: 08/13/2021 11:01:09 AM

Document Has Been Signed on 08/13/2021 11:01 AM - 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MEXICAN AMER. OPPORTUNITY FOUND. FREMONT PRESCH.FACILITY NUMBER:
364815787
ADMINISTRATOR:SUSANA GARCIAFACILITY TYPE:
850
ADDRESS:9950 FREMONT AVENUETELEPHONE:
(909) 626-1092
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY: 72TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
08/13/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Susan Garcia, DirectorTIME COMPLETED:
11:00 AM
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On 08/13/21 at 8:30am a case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 08/04/21. The report indicated an alleged possible personal rights violation. LPA was granted entry by Susana Garcia, Director.

Facility records were reviewed and a tour of the facility was conducted. LPA conducted staff and children interviews. Based on information gathered, the facility acted appropriately and no violations have been identified. Supervision and staff to child ratio is met; facility notification to Community Care Licensing within 24 hours including submission of Unusual Incident Report- LIC624 and facility notification to their corporate office.

An exit interview was conducted and a copy of this report and notice of site visit was provided to facility Director. This report must be made available to the public upon request for three years.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2021
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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