<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004841
Report Date: 01/28/2022
Date Signed: 01/28/2022 03:14:08 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:LONG BEACH CITY COLLEGE CDCFACILITY NUMBER:
198004841
ADMINISTRATOR:AMY BIGELOWFACILITY TYPE:
850
ADDRESS:4630 CLARK AVETELEPHONE:
(562) 938-4253
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:115CENSUS: 48DATE:
01/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Amy BigelowTIME COMPLETED:
03:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Warren Birks conducted a Case Management Incident inspection. This inspection is regarding an incident that took place on January 25, 2022. LPA met with Director Amy Bigelow who provided information and assistance during the inspection.

Staff #1 guided LPA to the classroom area to observe where child #1 was injured. LPA observed the area to appear to be in normal safe condition. LPA observed the area to be clean, orderly and free of hazards or damage. Staff #1 indicated she was approximately five (5) ft away when the injury took place. Staff #1 indicated child #1 leaned over a short indoor window ledge (approximately 2 feet tall). Child #1 then slipped while trying to kneel down and causing child #1 to hit the lower lip. Later child bit the lip causing more injury to that area. Staff #1 indicated that the ratio was three (3) staff and eleven (11) students at the time. Child #1 also indicated that staff #1 was within his vicinity when the injury took place.

Post injury, staff immediately conducted first aid and contacted parents for pick up. The child was taken to the hospital for medical treatment and returned to school the next day with no medical restrictions. Staff followed the required protocol in terms of first aid and "reporting requirements" as the 1/25/2022 incident was reported to Child Care Licensing within 24 hours or the next business day. The Information provided matches the incident report. 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 Director Amy Bigelow.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1