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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004841
Report Date: 11/20/2023
Date Signed: 11/20/2023 04:08:47 PM


Document Has Been Signed on 11/20/2023 04:08 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: 30DATE:
11/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Joana BaronTIME COMPLETED:
04:18 PM
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Licensing Program Analyst (LPAs) Warren Birks and Angelica Wallin conducted a Case Management Incident inspection. This inspection is regarding an incident that took place on November 16, 2023. LPA met with Administrative Assistant Joana Barron who provided information and assistance during the inspection.

Staff #1 and staff #2 separately guided LPAs to the outdoor area to observe where child #1 was injured. LPA observed the play equipment appear to be age appropriate and in normal condition (orderly and free of uncommon hazards). LPA also observed the sandbox area appear to be in adequate condition. Staff #1 and staff #2 indicated that staff #1 was approximately five to 10 feet away and observed child l#1 when the injury took place. LPA received disclosure from Child #1 and staff #1 that child #1 tripped and fell while going up the steps of playground equipment. Thus, sustaining a cut injury underneath the chin.

Post injury staff #1 and staff #2 conducted first aid washing and dressing the injury. A parent 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 November 16, 2023 incident was reported to Child Care Licensing within 24 hours (or the next business day). The facility also provided a written report within seven days. The Information provided matches the incident report. Based on interviews and observations there were no violations of Title 22 requirements at this time.

Note: LPA Birks did advise Admin Assistant Barron that yellow paint and/or yellow grip tape (along the edge of the steps) may help to prevent accidents. LPA explained that the yellow color may be helpful in alerting children where they step as they go up the playground equipment 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 Administrative Assistant Joana Barron.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2023
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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