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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600943
Report Date: 09/22/2022
Date Signed: 09/22/2022 03:42:38 PM

Document Has Been Signed on 09/22/2022 03:42 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BETHANY LUTHERAN CHURCH PRESCHOOLFACILITY NUMBER:
191600943
ADMINISTRATOR:TAMARA SIMPSONFACILITY TYPE:
850
ADDRESS:4644 CLARK AVETELEPHONE:
(562) 429-7335
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 81TOTAL ENROLLED CHILDREN: 81CENSUS: 59DATE:
09/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Tamara SimpsonTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management Incident inspection. This inspection is regarding an incident that took place on July 25, 2022. LPA met with Director Tamara Simpson who provided information and assistance during the inspection.

During the inspection LPA reviewed a written observation of events from Staff #1. Staff #1 indicated that she observed a rash on child #1 (in the morning). Eventually after a review of the Preschool Illness Policy, facility staff made a decision to contact parents to pick up the child. Note: The preschool policy is provided to every parent.

The child's parent disagreed with the child being sent home however, based on LPA's review of the Illness Policy, the facility followed proper protocol in regards to sending child #1 home with parents. In addition, it was also proper to request a doctor's note for return.

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. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Director Tamara Simpson.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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