198004841-3-9-2023-54-CC-WBIS-CPRVA2-20230309151513

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004841
Report Date: 03/09/2023
Date Signed: 03/09/2023 03:15:19 PM

Document Has Been Signed on 03/09/2023 03:15 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:	LONG BEACH CITY COLLEGE CDC		FACILITY NUMBER:	198004841
ADMINISTRATOR:	AMY BIGELOW		FACILITY TYPE:	850
ADDRESS:	4630 CLARK AVE		TELEPHONE:	(562) 938-4253
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY:	115	CENSUS: 45	DATE:	03/09/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:54 PM
MET WITH:	Amy Bigelow		TIME COMPLETED:	03:30 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 March 7, 2023. LPA met with Director Amy Bigelow who provided information and assistance during the inspection. Staff #1 guided LPA to the outdoor play area to observe where child #1 was injured. LPA observed the area to appear to be in normal condition (clean, orderly and free of hazards). LPA also observed the playground equipment to be in working condition. Staff #1 indicated they were approximately seven feet away observing the area (including child #1) when the injury took place. Based on the position of child #1 and staff #1, the injury was not preventable as child #1 was running up the playground structure. Staff #1 indicated child #1 was running up the stairs when the child tripped and fell forward hitting the underside of the chin.The fall caused child #1 to sustain a cut underneath the chin. Immediately post injury it was indicated that staff #2 assisted staff #1 administering first aid. The facility then contacted parents for pick up. The child was taken to the hospital for medical treatment and returned to school the next day with no restrictions. Note: LPA observed child #1 playing and interacting with no restrictions. Staff followed the required protocol in terms of first aid and "reporting requirements" as the 3/8/2023 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. CONTINUED....

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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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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: LONG BEACH CITY COLLEGE CDC	FACILITY NUMBER: 198004841
	VISIT DATE: 03/09/2023

NARRATIVE

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Note: LPA observed the play structure to be age appropriate and appear to be free of hazards. LPA did advise Director Amy Bigelow that it may help to apply strips of bright colored grip tape or paint a strip of the yellow on the edge of each stair. LPA indicated that the bright color may help children to be mindful of where they are stepping (when going up or down the stairs).

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 Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

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