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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006258
Report Date: 02/28/2020
Date Signed: 02/28/2020 12:36:30 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:BELMONT SHORE CHILDREN'S CENTERFACILITY NUMBER:
198006258
ADMINISTRATOR:ANNA MARTINEZFACILITY TYPE:
850
ADDRESS:30 S. TERMINOTELEPHONE:
(562) 439-3369
CITY:LONG BEACHSTATE: CAZIP CODE:
90803
CAPACITY:70CENSUS: 37DATE:
02/28/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:19 PM
MET WITH:Anna Martinez; DirectorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst(LPA) Reiko Jones-Modeste conducted a Case Management visit to amend a previous report(9099) dated 12/20/19.

LPA observed 37 napping preschoolers, three teachers and one aide.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with the Licensee Anna Martinez including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020
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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