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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191607980
Report Date: 10/06/2022
Date Signed: 10/06/2022 04:06:16 PM


Document Has Been Signed on 10/06/2022 04:06 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:LBUSD-HOLMES CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191607980
ADMINISTRATOR:CHRISTINA CORTEZFACILITY TYPE:
850
ADDRESS:5020 BARLIN AVENUETELEPHONE:
(562) 531-8519
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:21CENSUS: 14DATE:
10/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Fatima Barajas, Coordinating TeacherTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Katrina Chicote conducted an unannounced case management inspection on 10/06/2022 at 2:30 PM to follow up on an incident that was reported to the Department on 09/27/2022. Upon arrival, LPA met with Fatima Barajamas, Coordinating Teacher, who provided LPA a tour of the facility inside and outside. Facility is located on Holmes Elementary School campus. LPA observed required postings in classroom at time of inspection. LPA observed 14 children with four staff at time of inspection.

On 09/27/2022, an incident was reported to The Department in regards to construction beginning on 09/26/2022 on gate in outdoor playground. The facility reported this incident to the Department within the required 24 hours and written reported received within seven days. During this inspection LPA interviewed Coordinating Teacher about construction plans and any adjustments facility has had to make to accommodate construction. Per Coordinating Teacher, they have moved the temporary pick up/drop off location to another gate that is nearby current gate being worked on. LPA observed that this temporary pick up/drop off gate is easily accessible and still provides separate entrance to preschool program from rest of school population (photos taken). Per Coordinating Teacher, construction has not caused any disruptions to daily operations and children are able to safely use outdoor playground. LPA observed outdoor playground where construction is taking place. LPA did not observe any evidence of ongoing construction that would be hazardous at time of inspection. Per Coordinating Teacher, construction is half way done.

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.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview was conducted and report was reviewed with, Fatima Barajas.

Report Ends - Page 1 of 1
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2022
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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