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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191602044
Report Date: 06/07/2022
Date Signed: 06/07/2022 12:16:22 PM

Document Has Been Signed on 06/07/2022 12:16 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: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: 91CENSUS: 51DATE:
06/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:Natalie UgaldeTIME COMPLETED:
12:30 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) Warren Birks conducted an unannounced Case Management Incident inspection. This inspection is regarding a disclosure incident that took place June 2, 2022. LPA met with Director Natalie Ugalde who provided information and assistance for the inspection.

At approximately 12:00pm Director Ugalde provided the required incident report which is more than 24 hours from the date of the incident. LPA informed Director that per Title 22 regulations, this incident was required to be reported to the Child Care Licensing Department (CCLD) within 24 hours. Director Ugalde indicated that she was ready to report on June 2,2022 and was involved in reporting five covid-19 incidents the same day as this incident.

The facility is cited for "reporting requirements" as Title 22 Regulations require unusual incidents to be reported to CCLD within 24 hours verbally or written (Note: if verbal a written report is within 7 days).

Director Ugalde submitted the written Unusual Incident Report to LPA during today's visit. Therefore, LPA Birks cleared the citation the same day.

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
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
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 06/07/2022 12:16 PM - It Cannot Be Edited


Created By: Warren Birks On 06/07/2022 at 11:51 AM
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 DAY NURSERY - EAST BRANCH
FACILITY NUMBER: 191602044

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/14/2022
Section Cited
CCR
101212(D1C)

1
2
3
4
5
6
7
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours......(1) Events reported shall include the following:
1
2
3
4
5
6
7
Director Ugalde submitted an incident report detailing the incident during the inspection.

The citation is cleared 6/7/2022.
8
9
10
11
12
13
14
 (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.

*This requirement was not met as evidenced by: Facility failed to report a disclosure incident. This is a potential risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Karen Chambers
LICENSING EVALUATOR NAME:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2022


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