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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000663
Report Date: 06/11/2019
Date Signed: 06/11/2019 03:56:47 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 STARR KING HEAD STARTFACILITY NUMBER:
198000663
ADMINISTRATOR:MARSHAE JACKSONFACILITY TYPE:
850
ADDRESS:145 E. ARTESIATELEPHONE:
(310) 422-3784
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:37CENSUS: 0DATE:
06/11/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Santiago AguilarTIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management-Incident inspection. This inspection is regarding incident/injury that took place on May 31, 2019. Licensing Program Analyst met with Head Teacher Santiago Aguilar.

Staff #1 and Staff #2 guided LPA to outdoor play area where child #1 was injured. LPA observed the area to be clean and free of hazards. The outdoor area and equipment appeared to be in safe and good condition. Staff #1 was in the vicinity of the incident where the child was injured and indicated that child #1 fell and hit her chin on the slide sustaining an injury to the teeth and gums. The child was given first aid immediately and parents were contacted.

Note: The child was taken to the dentist for medical treatment. The child is at school as of June 11, 2019 (with no restrictions). Staff followed the required protocol in terms of first aid and "reporting requirements" as the incident was reported to Child Care Licensing within the required 24 hours. Based on interviews and observations 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 Head Teacher Santiago Aguilar.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
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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