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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670722
Report Date: 12/09/2021
Date Signed: 12/09/2021 06:11:44 PM

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-GRANT CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191670722
ADMINISTRATOR:KIMBERLY KELLYFACILITY TYPE:
850
ADDRESS:6405 WALNUT AVETELEPHONE:
(562) 422-4686
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:95CENSUS: 20DATE:
12/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Kimberly Kelly, Coordinating Teacher TIME COMPLETED:
04:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection on 12/09/21. LPA arrived at the facility at 1:40PM and was met by Kimberly Kelly, Coordinating Teacher, who guided analyst on a tour of the facility. There were 20 napping children present with 2 staff supervising upon arrival.

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

LPA Ramos conducted interviews and obtained documentation during this visit.

The incident that occurred on 11/15/21, was reported to the Department on 11/24/21, via fax. The facility did not report the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that Child #1 sustained an injury that required medical attention.

LPA will need to conduct a follow-up visit for the incident due to insufficient information available at this time. However, due to the facility failing to report the incident within the required time, the following deficiency is being cited in accordance with California Code of Regulations Title 22.

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 Kimberly Kelly, 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: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LBUSD-GRANT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191670722
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2021
Section Cited

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Reporting Requirements:

(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours....
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This requirement is not met as evidenced by Licensee reporting the incident that occurred on 11/15/21 on 11/24/21 which poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2021
LIC809 (FAS) - (06/04)
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