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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004841
Report Date: 04/19/2023
Date Signed: 04/19/2023 04:00:07 PM


Document Has Been Signed on 04/19/2023 04:00 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 CDCFACILITY NUMBER:
198004841
ADMINISTRATOR:AMY BIGELOWFACILITY TYPE:
850
ADDRESS:4630 CLARK AVETELEPHONE:
(562) 938-4253
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:115CENSUS: 34DATE:
04/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:04 PM
MET WITH:Amy BigelowTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Warren Birks conducted a Case Management Incident inspection. This inspection is regarding an incident that took place on April 14, 2023. LPA met with Director Amy Bigelow who provided information and assistance during the inspection.

Staff #1 guided LPA to the outdoor area to observe where child #1 was injured. LPA observed the area to appear to be in normal condition (orderly and free of uncommon hazards). LPA also observed the all riding equipment appear to be in adequate condition. Staff #1 and Director Bigelow indicated they were approximately two and five feet away observing child l#1 when the injury took place. Child #1 fell off a tricycle/riding equipment and sustain an injury near the chin/mouth area. Staff #1 and Staff #2 indicated that there were both in the vicinity when the injury took place.

Post injury Staff #1 conducted first aid. Parents arrived at the school and the child was taken to the hospital for medical treatment. Child returned to school the following day with no restrictions. Staff followed the required protocol in terms of first aid and "reporting requirements" as the 4/14/2023 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.


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: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2023
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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