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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191602930
Report Date: 09/07/2022
Date Signed: 09/07/2022 04:42:15 PM

Document Has Been Signed on 09/07/2022 04:42 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:ISABEL PATTERSON CDCFACILITY NUMBER:
191602930
ADMINISTRATOR:MARIKOS, RHONDAFACILITY TYPE:
840
ADDRESS:5700 ATHERTON STTELEPHONE:
(562) 985-5333
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 37DATE:
09/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Alec ColchicoTIME COMPLETED:
04:55 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 September 1, 2022. LPA met with Director Alec Colchico who provided information and assistance during the inspection.

During the inspection, LPA interviewed child #2, staff #1, staff #2, staff #3 and Director Colchico. Child #1 was not available for interview at this time. Staff #2 guided LPA to the playground area where child #1 was accidentally injured by a child size miniature shovel. Staff #2 indicated that staff #2 was within a 10 feet proximity to child #1 (when child #1 was injured). Note: The facility no longer uses the child size miniature shovels for the outdoor digging area. LPA observed the area to be clean, free of abnormal hazards and appearing to be in safe good condition.

Based on visual descriptions from child #2, child #2 indicated the incident happened while child #2 was using a miniature shovel on a wood stump and accidentally hit child #1. Staff #1 and #2 indicated child #1 sustained a small cut in the back of the head and was immediately given first aid. Staff #1 also indicated there were three staff and 20 children when the incident occurred.

Note: The child was taken to the doctor for medical treatment. Staff followed the required protocol in terms of first aid and "reporting requirements" as the 9/1/2022 incident was reported to Child Care Licensing within the required 24 hours (9/2/2022). LPA will conduct a follow up at a later date to retrieve additional information.

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 Alec Colchico.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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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