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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018969
Report Date: 02/21/2024
Date Signed: 02/21/2024 12:05:34 PM


Document Has Been Signed on 02/21/2024 12:05 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:LBUSD-POWELL CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198018969
ADMINISTRATOR:NANCY PEREZFACILITY TYPE:
850
ADDRESS:150 VICTORIA ST.TELEPHONE:
(310) 631-8987
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:48CENSUS: 34DATE:
02/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Maria Davis, Teacher TIME COMPLETED:
12:20 PM
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On 02/21/2024 at 11:15 AM Licensing Program Analysts (LPAs) Katrina Chicote and Claudia Kam conducted an Unannounced Case management Inspection to follow up on an incident that was reported to the Department on 01/29/2024. Upon arrival, LPAs announced purpose of inspection and met with Facility Representatives, who granted entry to facility. Census was taken.

On 01/29/2024, an incident was reported to The Department where a child sustained an injury while in care. The facility reported this incident to the Department within the required 24 hours and submitted written report within seven days.

During this inspection LPAs interviewed staff, observed room incident took place in, and observed child named in report. Teacher informed Licensing that a child cut the tip of their finger with scissors. Teacher stated this incident occurred during clean up time and were notified by incident when the child notified Aide and Aide observed child's finger bleeding. Teacher states they applied immediate first aid, by cleaning wound and wrapping with a bandage. Teacher states that after child continued to play and injury did not appear to stop child from daily activities. Parent was informed and child picked up after lunch time. Per Teacher, parent consulted doctor through telehealth and was cleared to return the next day. Per Teacher, scissors have been placed out of reach of child. LPAs observed the indoor classroom where the incident took place and observed scissors to be stored on high shelf at time of inspection. LPAs observed child present at the facility and playing outside freely not affected by any injury. Based on the information obtained and LPAs observation LPAs determined there was adequate supervision and Facility Representatives made necessary adjustments after incident.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today.
A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Facility Representative.
Report Ends - Page 1 of 1

SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024
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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