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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006682
Report Date: 04/27/2022
Date Signed: 04/27/2022 05:00:24 PM


Document Has Been Signed on 04/27/2022 05:00 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 DAY NURSERY - EAST BRANCHFACILITY NUMBER:
198006682
ADMINISTRATOR:MONICA LOPEZFACILITY TYPE:
830
ADDRESS:3965 BELLFLOWER BOULEVARDTELEPHONE:
(562) 421-1488
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:95CENSUS: 4DATE:
04/27/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:Natalie UgaldeTIME COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management Incident inspection. This inspection is regarding an incident/injury that took place on April 21st, 2022. Licensing Program Analyst met with Director Natalie Ugalde who providing assistance for the inspection.

Director indicated that staff #1 was unavailable at the time. LPA conducted interview with staff #2 who witnessed the incident. LPA informed Director that LPA will interview staff #1 at a later date. LPA also interviewed Director Ugalde, reviewed child #1's file and reviewed incident report documentation (which indicate child #1 sustained an injury requiring medical).

Note: The child is currently back at the childcare facility with no medical restrictions. The incident was reported to Child Care Licensing in a timely manner (within 24 hours).

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 Natalie Ugalde.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2022
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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