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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670550
Report Date: 06/14/2022
Date Signed: 06/14/2022 02:59:38 PM


Document Has Been Signed on 06/14/2022 02:59 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-BURBANK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191670550
ADMINISTRATOR:TIFFANY SANCHEZFACILITY TYPE:
850
ADDRESS:535 JUNIPERO AVETELEPHONE:
(562) 438-4108
CITY:LONG BEACHSTATE: CAZIP CODE:
90814
CAPACITY:74CENSUS: 0DATE:
06/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Tiffany Sanchez, Coordinating Teacher TIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection on 06/14/22 due to an incident that occurred on 06/10/22. LPA met with Tiffany Sanchez, Coordinating Teacher, who guided LPA on a tour of the facility. There were no children present upon arrival. All children had gone home after their end-of- the-year celebration. There were 4 staff present upon arrival.

The purpose of the visit was to follow-up on an incident that was reported to the department.

LPA conducted interviews and obtained documentation during this visit.

The incident that occurred on 06/10/22, was reported to the Department on 06/10/22, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that Child #1 began to choke on their food and Adult #1 did the Heimlich maneuver.

Based upon information received from the interviews conducted it was determined that Child #1 did not require any medical attention. Parent was present the entire time. Staff certified in Pediatric First Aid and CPR were present.

There were no deficiencies cited during today’s inspection. LPA advised Coordinating Teacher to review regulation on food services.

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. Exit interview was conducted with TIffany Sanchez, Coordinating Teacher, including, but not limited to Provider Rights, Appeal Procedures.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
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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