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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600444
Report Date: 12/06/2023
Date Signed: 12/06/2023 05:25:17 PM


Document Has Been Signed on 12/06/2023 05:25 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:LONG BEACH CENTER-ABILITY FIRSTFACILITY NUMBER:
191600444
ADMINISTRATOR:APRIL STOVERFACILITY TYPE:
840
ADDRESS:3770 EAST WILLOW ST.TELEPHONE:
(562) 426-6161
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:80CENSUS: 30DATE:
12/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:April StoverTIME COMPLETED:
05:35 PM
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Licensing Program Analyst (LPA) Warren Birks conducted a Case Management Incident inspection. This inspection is regarding an incident that took place on November 30, 2023. LPA met with Center Director April Stover and Program Supervisor Jamie Briseno who provided information and assistance during the inspection.

Staff #1 guided LPA to the outdoor activity area to observe where client #1 was injured. LPA observed the area appear to be in normal condition (orderly and free of uncommon hazards). LPA also observed the cushioned ground area to be in normal condition. Staff #1 indicated Staff #1 was approximately one to two feet away assisting client #1 with walking when client #1 fell to the ground. Thus, sustaining minor abrasion on the face, hands and knees. Staff indicated they were the vicinity when the injury took place.

Post injury Staff #1 and Staff #2 conducted first aid, and facility contacted a parent. Client #1 was taken to the hospital for medical treatment and parent reported the client was discharged without any treatment at this time. Parent also indicated that client #1 will attend school in the morning and will notify Ability First when he will return to the facility.

Staff followed the required protocol in terms of first aid and "reporting requirements" as the 11/30/2023 incident was reported to Child Care Licensing within 24 hours (or the next business day). In addition, the Licensee provided a written incident report within the seven day requirement. The Information provided matches the incident report. Based on interviews and observations there were no violations of Title 22 requirements at this time.

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. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Program Supervisor Jamie Briseno.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
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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