<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600444
Report Date: 12/17/2024
Date Signed: 12/17/2024 01:45:54 PM

Document Has Been Signed on 12/17/2024 01:45 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:LONG BEACH CENTER-ABILITY FIRSTFACILITY NUMBER:
191600444
ADMINISTRATOR/
DIRECTOR:		APRIL STOVERFACILITY TYPE:
840
ADDRESS:3770 EAST WILLOW ST.TELEPHONE:
(562) 426-6161
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 80TOTAL ENROLLED CHILDREN: 42CENSUS: 0DATE:
12/17/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Administrator / April StoverTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Ashley Calderon conducted an Case Management Annual Continuation Inspection and met with Administrator April Stover. LPA disclosed the purpose of the inspection and was granted entry into the facility by Administrator.

LPA Calderon along side with A.Stover conducted a tour of the facility. LPA observed After School day care room, census: 0 during time of LPA's observation. LPA conducted a tour of the pool which was being used by Adults from the Community. LPA discussed New Stature AB-2866 Pool Safety Assembly Bill.

LPA provided Facility with Lead Sample- All Results documentation to post in a prominent area.

LPA reviewed Child #4 (C4) Physician's Report and LPA reviewed (4) staff records to verify vaccination records. LPA conducted file record review at 12:20pm, it was observed for Staff #1 (S1) Pertussis (TDAP) vaccination was not recorded on vaccination record and Staff #4 (S4) Measles, Mumps and Rubella (MMR) and TDAP vaccination records was not in file. Per Administrator April Stover, informed LPA Calderon will request S1 to submit an updated Vaccination Record and A.Stover stated S4 records are missing and not in file. LPA took pictures of staff files.

Based on record review, Per California Code of Regulation Title 22, there was (1) deficiency cited on today's visit, Type B.

A notice of site visit was provided to Administrator April Stover understands form must remain posted for 30 days.



Exit interview conducted and report was reviewed with Administrator April Stover.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/17/2024 01:45 PM - It Cannot Be Edited


Created By: Ashley Calderon On 12/17/2024 at 01:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: LONG BEACH CENTER-ABILITY FIRST
FACILITY NUMBER: 191600444

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA Calderon and Administrator Stover's observation of record review Staff #1 and Staff #4 had missing required immunization records on file, and interview with A.Stover stated Staff #4 records are not in file, the facility did not comply with the section cited above in [2] out of [4] staff records, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/18/2024
Plan of Correction
1
2
3
4
During time of visit Staff #1 and Staff #4 were scheduled a doctors appointment obtain records and vaccinations if needed.
Administrator will provide LPA Calderon with vacination records. Staff #4 vaccination was provided at approx 1:30pm. At approx 1:40pm Staff #1 vaccination was provided. LPA reviewed records at the facility and POC was cleared during visit.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Denise Gibbs
LICENSING EVALUATOR NAME:Ashley Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2