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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670722
Report Date: 05/20/2022
Date Signed: 05/20/2022 12:02:06 PM


Document Has Been Signed on 05/20/2022 12:02 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-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: 38DATE:
05/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:26 AM
MET WITH:Kimberly Kelly, Coordinating TeacherTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) RIta Ramos conducted an unannounced case management inspection on 05/20/22. LPA met with Kimberly Kelly, Coordinating Teacher, who provided LPA with a tour of the facility. There 38 children present with 10 staff upon arrival.

The purpose of the visit was to address an incident that occurred between 04/11/22 - 04/13/22 in which facility staff became aware of but did not report the incident to the department.

LPA advised staff during the inspection that any incident addressed to facility staff pertaining to the possibility of a child's personal rights being violated should be reported to the department.

Due to the facility not reporting the incident, the following deficiency on the deficiency page is being cited in accordance with California Code of Regulations Title 22.

LPA advised that the deficiency is a repeat violation within the last 12 months. No civil penalties can be assessed due to the facility being part of a school district. LPA advised Coordinating Teacher that reporting requirements is of concern.

The Notice of Site Visit must remain posted for 30 days. Exit interview was conducted with Kimberly Kelly, Coordinating Teacher, which includes appeal rights and procedures.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
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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Document Has Been Signed on 05/20/2022 12:02 PM - It Cannot Be Edited

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: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2022
Section Cited

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Reporting Requirements

(d)(1) 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 requirment was not met as evidenced by facility staff failing to report an incident
in which a child's personal rights may have been violated 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: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
LIC809 (FAS) - (06/04)
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