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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019033
Report Date: 09/03/2021
Date Signed: 09/03/2021 02:52:19 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:ADULT SCHOOL-EARLY HEAD STARTFACILITY NUMBER:
198019033
ADMINISTRATOR:KIMBERLY YOUNG & TINA EASTFACILITY TYPE:
830
ADDRESS:3701 E. WILLOW ST.TELEPHONE:
(562) 989-4679
CITY:LONG BEACHSTATE: CAZIP CODE:
90755
CAPACITY:8CENSUS: 4DATE:
09/03/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Natasha Jackson, Early Learning Center ManagerTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection due to an incident that occurred on 08/10/21. LPA met with Natasha Jackson, Early Learning Center Manager, and Rhoshanda Vantura, Teacher, who guided LPA on a tour of the facility. There were 4 children and 2 staff present upon arrival.

The purpose of the visit was to follow-up on an incident that was reported to the department.

LPA conducted interviews and obtained documentation during this visit.

The incident that occurred on 08/10/21, was reported to the Department on 08/10/21, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that Child #1 drank from Staff #3's drinking cup.

Based upon information received from the interviews conducted and documentation obtained it was determined that Child #1 was not supervised when they managed to get a hold of Staff #3's drink. Interviews conducted were unclear as to whether or not Child #1 actually drank from the cup or if Child #1 only placed their mouth on the cup. The incident poses a potential health and safety risk to children in care.

The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22.

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. Exit interview was conducted with Natasha Jackson, Early Learning Center Manager, including, but not limited to Provider Rights, Appeal Procedures.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
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: ADULT SCHOOL-EARLY HEAD START
FACILITY NUMBER: 198019033
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2021
Section Cited

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Responsibility for Providing Care and Supervision for Infants

(a)(1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times.

This requirement is not met as evidenced by
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interviews and documentation obtained indicating that Child #1 had access to Staff #3's cup and may or may have not drank out of it. This poses a potential health and safety risk to 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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 09/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2021
LIC809 (FAS) - (06/04)
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