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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601818
Report Date: 09/28/2023
Date Signed: 09/28/2023 04:08:43 PM

Document Has Been Signed on 09/28/2023 04:08 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:DOROTHY AHRENS NURSERY SCHOOLFACILITY NUMBER:
191601818
ADMINISTRATOR:AHRENS-SALLEY,NANCYFACILITY TYPE:
850
ADDRESS:4960 LONG BEACH BLVDTELEPHONE:
(562) 423-3880
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 63TOTAL ENROLLED CHILDREN: 47CENSUS: 33DATE:
09/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Licensee - Nancy AhrensTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Randy Derraco conducted a case management inspection to the above mentioned facility on 09/28/23. LPA began case management inspection with licensee, Nancy Ahrens, at 2:50 PM. LPA observed 33 children in care and 5 adults in attendance during the inspection. The purpose of this visit is to issue a Type B citation due to the facility failing to report an unusual incident.

LPA conducted an interview with licensee, Nancy Ahrens, regarding the discipline policy indicated in the parent handbook. During the interview, licensee disclosed that forms of discipline for misbehaving children are kept "in house" where she and her staff deal with the issue on a personal level to keep the overall discipline of the child within the facility. LPA referenced an incident involving a teacher and child holding pine needles, where the child was injured, however no unusual incident report was given to the Department. LPA reviewed the guidelines and procedures of filing an unusual incident report with Department, with licensee Nancy Ahrens. LPA advised licensee that a citation under California Code of Regulation (CCR) section 101212(d)(1)(C) will be issued.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights provided and report was reviewed with the licensee

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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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Document Has Been Signed on 09/28/2023 04:08 PM - It Cannot Be Edited


Created By: Randy Derraco On 09/28/2023 at 03:27 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: DOROTHY AHRENS NURSERY SCHOOL
FACILITY NUMBER: 191601818

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/12/2023
Section Cited
CCR
101212(d)(1)(C)

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101212 Reporting Requirements (d)...a report shall be made to the Department by telephone or fax within the Department's next working day... (1) events Events reported shall include the following (D) Any unusual incident...This requirement is not met as evidenced by:
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Licensee states she will complete a declaration stating that she has reviewed online resources on how to file a UIR.
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Based on observation, interview and record review, the licensee did not report an unusual incident by the next business day which poses a potential Health, safety and/or personal rights risk to persons 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:Denise Gibbs
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023


LIC809 (FAS) - (06/04)
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