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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011608
Report Date: 10/01/2019
Date Signed: 10/01/2019 01:29:53 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:OAKWOOD ACADEMYFACILITY NUMBER:
198011608
ADMINISTRATOR:CATHERINE MATSUBARAFACILITY TYPE:
850
ADDRESS:3850 LONG BEACH BOULEVARDTELEPHONE:
(562) 426-6264
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:114CENSUS: 96DATE:
10/01/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Ana SanchezTIME COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Warren Birks and Alicia Mooberry conducted an unannounced case management inspection. LPA met with Director Ana Sanchez who provided information for the inspection. The visit is in regard to an incident that took place on June 5th, 2019 and reported to the department on June 17, 2019. Director Sanchez, indicated she called the department on June 6th, 2019 however she could not reach a representative.

Although the incident was reported and an incident form was submitted, there is no evidence that incident was reported within the required 24 hours (by 6/6/2019). Director Sanchez indicated that she will ensure that incidents are reported timely and she will document dates incidents are reported. LPA advised Director to fax incident reports to ensure documentation has a date and time stamp recorded.

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 reprehensive. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Director Ana Sanchez.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: OAKWOOD ACADEMY
FACILITY NUMBER: 198011608
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2019
Section Cited

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Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. LPA observed that there is no eveidence that an incident report was reported within 24 hours.
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This may also apply to date the report received as well as LPA observed notes that the incident report was mailed 6/13/19 (for a 6/5/19 incident). Written reports are due within 7 days after the initial 24 hour notification to the department. This poses a potential risk for children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2019
LIC809 (FAS) - (06/04)
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