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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007146
Report Date: 06/01/2022
Date Signed: 06/01/2022 11:29:27 AM


Document Has Been Signed on 06/01/2022 11:29 AM - 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:EDGEWATER PRESCHOOLFACILITY NUMBER:
198007146
ADMINISTRATOR:ANDREA GALLAGHERFACILITY TYPE:
850
ADDRESS:5270 ATHERTON STREETTELEPHONE:
(562) 597-5913
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:55CENSUS: 48DATE:
06/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Eliana CaebajalTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management Incident inspection. This inspection is regarding an incident that took place on May 25, 2022. LPA met with Director Eliana Carbajal who provided information and assistance during the inspection.

During the inspection LPA interviewed Staff #1, Staff #2 and Staff #3. Staff #2 guided LPA to the playground area where child #1 was injured. LPA observed the area to be clean, free of abnormal hazards and appearing to be in safe good condition. LPA also observed the playground table appearing to be an age appropriate height (about 1 1/2 feet high). LPA observed tapped padding along the four corners (however the table is dated with the outer edges made of steel). LPA advised Director that non-steel equipment is the current industry standard. Staff #2 indicated she was approximately three to four ft away when the child was injured, Staff #2 indicated child #1 jumped off the table, landed awkwardly and fell on the table; thus sustaining a cut on the forehead above the left eye. Staff also indicated there were three staff and 11 children in care at the time.

Note: The child was taken to the doctor for medical treatment and returned to school the next day with no restrictions. Staff followed the required protocol in terms of first aid and "reporting requirements" as the 5/24/2022 incident was reported to Child Care Licensing within the required 24 hours (5/25/2022). 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 Eliana Carbajal.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
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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