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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000638
Report Date: 12/21/2022
Date Signed: 12/21/2022 12:18:07 PM


Document Has Been Signed on 12/21/2022 12:18 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:YOUNG HORIZONS CHILD DEVELOPMENT CENTERSFACILITY NUMBER:
198000638
ADMINISTRATOR:ARIANA CHAVEZFACILITY TYPE:
850
ADDRESS:501 ATLANTIC AVETELEPHONE:
(562) 437-8991
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY:65CENSUS: DATE:
12/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Ariana ChavezTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPAs) Warren Birks and Austin Estrada conducted an unannounced Case Management Incident inspection. This inspection is regarding incident that took place on November 16, 2022. Licensing Program Analysts met with Site Supervisor Ariana Chavez who providing information and assistance for the inspection.

During the course of the inspections, LPA conducted interview with staff #1 who witnessed the incident first hand. LPA also interviewed staff #2 and staff #3 who indicated that staff #1 was in the presence of child #1. Staff #2 and #3 did not witness the incident first hand but did observe first aid treatment afterwards.

LPA reviewed internal reports provided by the facility and received notification from the facility in a timely manner (within 24 hours by phone and within 7 days written). There were no corroborated disclosures which indicate that a Title 22 violation occurred regarding the incident. Based on interviews and review of internal reports there were no violations of Title 22 requirements.

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. Exit interview was conducted with Site Supervisor Ariana Chavez.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022
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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