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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670974
Report Date: 03/30/2022
Date Signed: 03/30/2022 11:45:29 AM


Document Has Been Signed on 03/30/2022 11:45 AM - 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-MANN CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191670974
ADMINISTRATOR:ROBBIE WADELLFACILITY TYPE:
850
ADDRESS:3215 E VISTA AVETELEPHONE:
(562) 439-7896
CITY:LONG BEACHSTATE: CAZIP CODE:
90803
CAPACITY:48CENSUS: 21DATE:
03/30/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Nancy Perez, Coordinating Teacher TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection due to an incident that occurred on 03/04/22. LPA met with Nancy Perez, Coordinating Teacher, who guided LPA on a tour of the facility. There were 3 staff and 2 volunteers with 21 children present upon arrival.

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

LPA conducted interviews and obtained documentation during this visit.

The incident that occurred on Friday 03/04/22, was reported to the Department on Tuesday 03/08/22, via the Department's incident report email drop box at 1:37PM. The facility did not report the Unusual Incident to the Department within the required 24 hours of occurrence or within the next business day.

Information reported to the Department pertained to an incident that occurred between Child #1 and Child #2 where Staff #2 supervised and observed the incident. Staff #2 reported the incident to Staff #3 per their internal staff policies and procedures. Staff #3 failed to report the incident in a timely manner to the department. LPA discussed reporting requirements with Staff #1 during today's inspection. And although Staff #1 was not available the day of the incident, LPA advised that Licensee review reporting requirements with all staff to ensure that reports are made timely to the department.

Based upon information received from the interviews conducted pertaining to the incident, it was determined that there is no violation of Title 22. However, due to the facility not reporting the incident to the department in a timely manner, LPA issued a Technical Violation. The Notice of Site visit must remain posted for 30 days. Exit interview was conducted with Nancy Perez, 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: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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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