MAOF HEAD START ZOE AVENUE CENTER

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2512/9/25 at 12:45PM, The Licensing Program Analyst (LPA), T. Tran, conducted an unannounced visit at MAOF- Zoe Head Start following up on a self reported case management incident which occurred on 11/19/25. At 1:00PM, LPA met with head teacher, Araceli Garcia and toured the facility inside and outside. LPA observed the children were napping. No concerns with napping staff/children ratio. During today's visit, LPA completed staff and child files reviewed. LPA obtained the child's document and attendance sheet. Based on records reviewed and interview conducted with staff, school nurse, and parent. On 11/19/25, S1 (see LIC 811) admitted that the C1 was released to the family member that was not listed on the emergency card. Upon acknowledging this incident, staff immediately conducted a home visit, however no one was home. The facility staff contacted C1 parents and confirmed that C1 was with them and safe. Due to the holiday break, the child returned to school on 12/2/25. Based on the facts presented and the information that was gathered through interviews and record reviewed, this incident was the result of Title 22 Regulations violation for the child's Personal Rights. Per facility representative training will be conducted with center staff on the topic of children's personal rights and pick-up procedures. Then submit to the department the training materials along with a sign-in sheet of all staff in attendance by 12/19/25. Type B deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the facility representative, Araceli Garcia. NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs NAME OF LICENSING PROGRAM ANALYST: Tiffanie Tran LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/09/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2025 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 3 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 informatio

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2512/9/25 at 12:45PM, The Licensing Program Analyst (LPA), T. Tran, conducted an unannounced visit at MAOF- Zoe Head Start following up on a self reported case management incident which occurred on 11/19/25. At 1:00PM, LPA met with head teacher, Araceli Garcia and toured the facility inside and outside. LPA observed the children were napping. No concerns with napping staff/children ratio. During today's visit, LPA completed staff and child files reviewed. LPA obtained the child's document and attendance sheet. Based on records reviewed and interview conducted with staff, school nurse, and parent. On 11/19/25, S1 (see LIC 811) admitted that the C1 was released to the family member that was not listed on the emergency card. Upon acknowledging this incident, staff immediately conducted a home visit, however no one was home. The facility staff contacted C1 parents and confirmed that C1 was with them and safe. Due to the holiday break, the child returned to school on 12/2/25. Based on the facts presented and the information that was gathered through interviews and record reviewed, this incident was the result of Title 22 Regulations violation for the child's Personal Rights. Per facility representative training will be conducted with center staff on the topic of children's personal rights and pick-up procedures. Then submit to the department the training materials along with a sign-in sheet of all staff in attendance by 12/19/25. Type B deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the facility representative, Araceli Garcia. NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs NAME OF LICENSING PROGRAM ANALYST: Tiffanie Tran LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/09/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2025 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 3 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 informatio

Type B citation - potential risk if not corrected