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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191602044
Report Date: 07/02/2021
Date Signed: 07/02/2021 09:32:10 AM

Document Has Been Signed on 07/02/2021 09:32 AM - 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:LONG BEACH DAY NURSERY - EAST BRANCHFACILITY NUMBER:
191602044
ADMINISTRATOR:MONICA LOPEZFACILITY TYPE:
850
ADDRESS:3965 BELLFLOWER BLVD.TELEPHONE:
(562) 421-1488
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 91TOTAL ENROLLED CHILDREN: 0CENSUS: 18DATE:
07/02/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:22 AM
MET WITH:Stephanie TjandraTIME COMPLETED:
09:32 AM
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Licensing Program Analyst (LPA) Warren Birks conducted a follow up unannounced Case Management-Incident inspection. This inspection is regarding incident that took place on June 17, 2021. Licensing Program Analyst met with Associate Center Director Stephanie Tjandra. This inspection is to close out the incident as LPA gathered additional information.

During a previous inspection, Staff #1 guided LPA to outdoor play area where child #1 was injured. LPA observed the area to be clean, free of hazards and appearing to be in safe good condition. Play equipment also appeared to be in good condition with no loose or broken parts. Staff #1 indicated child #1 was playing/hiding underneath a play equipment platform and bumped his/her head (thus sustained an injury to the top of the head). Staff #1 indicated she was present near the play equipment where child #1 sustained the injury. Staff #1 also stated she was caring for 10 children (which is within Title 22 teacher-child ratio).

After the injury, Staff #1 asked the child questions to determine if the child was coherent and immediately took the child to receive first aid. Parents were contacted and they picked up the child to receive medical treatment. Child #1 was cleared to return the next day (with no restrictions). Note: On June 22, 2021, LPA observed child #1 appearing to play without any restrictions. Staff followed the required protocol in terms of first aid and "reporting requirements" as the incident was reported to Child Care Licensing within the required 24 hours.

LPA received additional disclosure from Adult #1 and based on all interviews and information gathered, there were no Title 22 violations regarding this incident.

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 Assistant Director Stephanie Tjandra
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2021
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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