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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600444
Report Date: 01/02/2025
Date Signed: 01/02/2025 02:38:47 PM

Document Has Been Signed on 01/02/2025 02:38 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: 30CENSUS: 4DATE:
01/02/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Director - April StoverTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced case management visit to the above mentioned facility on 01/02/25. LPA arrived at the facility at 9:30 AM and was met by Director, April Stover, who guided analyst on a tour of the facility. LPA observed 2 additional teachers and 4 children in care. The facility's physical plant was observed to be in compliance with Title 22 California Code of Regulations

The purpose of this visit is to follow up with an Unusual Incident Report dated 12/31/24. During the inspection, LPA conducted interviews, reviewed records, took photographs, obtained training material, and obtained a roster. Individuals interviewed state that S1 sent C1 from the adult day care room to the child day care room on 12/30/24. Prior to sending C1 to the child day care room, S1 used a walkie-talkie to inform staff that C1 will be walking from the adult day care room to the child day care room. Individuals interviewed state that S1 never received audio or visual confirmation that C1 was received in the child day care room. Individuals interviewed confirmed that the client grabbed their personal belongings from the child day care room and proceeded to walk out the front door at 3:13PM on 12/30/24. The client was found safe and uninjured.

Individuals interviewed state that protocol includes a staff member using the walkie-talkie to advise that a client is currently moving from their current position to a new position. The receiving staff member confirms or "copies" the request via walkie-talkie. in addition to the communication over walkie-talkies, the sending staff member must keep a visual on the client as they walk from one area to another. A visual confirmation is also given by both staff members to confirm the client has reached their destination. Individuals interviewed confirm that there was a breakdown in protocol which resulted in an absence of supervision. LPA advised Director that a Type A citation under California Heath and Safety Code section 1596.99(c)(3) will be issued along with an immediate Civil Penalty of $500.
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LONG BEACH CENTER-ABILITY FIRST
FACILITY NUMBER: 191600444
VISIT DATE: 01/02/2025
NARRATIVE
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LPA R. Derraco informed Director April Stover that this report dated 01/02/25 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA R. Derraco informed the Director April Stover to provide a copy of this licensing report dated 01/02/25 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director April Stover.


(page 2 of 2)
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/02/2025 02:38 PM - It Cannot Be Edited


Created By: Randy Derraco On 01/02/2025 at 01:49 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: 01/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/03/2025
Section Cited
HSC
1596.99(c)(3)

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1596.99 Levy of civil penalty...(c) The department shall assess an immediate civil penalty of $500 per violation...for any of the following serious violations:(3) Absence of supervision, including, but not limited to, a child left unattended...This requirement is not met as evidenced by:
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Director states that all staff will be required to review training materials on Missing Persons and Activer Supervision traiing by 01/15/25. Additionally, admins are now required to be at the front desk when volunteers are absent and not available. There will also be a staff
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Based on observation, interview and record review, the facility left a client unattended resulting in the client wandering off. This poses an immediate health, safety and/or personal rights risk to persons in care.
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member in the child care room going forward and the front door will be locked after 4PM.

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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:Denise Gibbs
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/02/2025


LIC809 (FAS) - (06/04)
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