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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191605376
Report Date: 06/25/2024
Date Signed: 06/25/2024 04:25:55 PM

Document Has Been Signed on 06/25/2024 04:25 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:UNITED FAITH COMMUNITY DAY CARE CENTERFACILITY NUMBER:
191605376
ADMINISTRATOR/
DIRECTOR:		CAROL SANDERSFACILITY TYPE:
850
ADDRESS:6934 LONG BEACH BLVD.TELEPHONE:
(310) 639-0434
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 17DATE:
06/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Carol Sanders, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On Wednesday, June 25, 2024, Licensing Program Analysts (LPA) Keneisha Dunlap, and Franchesca White arrived for an unannounced Case Management - Incident inspection based on an Unusual Incident Report (UIR) received to the department on June 18, 2024. LPA White announced the purpose of the visit and was granted entry into the facility by Licensee, Carol Sanders. LPA Dunlap was introduced as the caseload carrying LPA for this facility. There are 7 day care children enrolled and 16 children present at the time of inspection. 5 daycare children present in classroom, 4 children who are 4 years of age (upstairs in an off limits area), 2 children 5 years of age (upstairs in an off limits area), 5 school-age children ages 8-9 (upstairs in an off limits area), and one infant (upstairs in an off limits area).

LPA Dunlap conducted interview with Licensee regarding UIR. Licensee stated that on June 18, 2024 that child was playing outside on Playground 1 with another child. The child was climbing on the other child's back. While climbing on other child, the child fell back and hit their head on brick wall. Licensee stated that there were 2 staff present Staff #2 and Staff #3. Licensee stated that they checked to make sure there were no injures on the child and found that child has small cut on head. Licensee stated they applied water to cut and wiped it. Licensee stated when the child was picked up that the child's parent was informed of incident. Licensee provided typed incident report to LPA Dunlap during inspection. Licensee stated that parent could not find cut and pointed to where it was on child's head. Licensee stated that parent was infuriated and stated that they would be taking child to hospital.

LPA Dunlap conducted interview with Staff #2 they stated that they were present on Playground 1. Staff #2 did not speak with parent regarding incident. Staff #2 did not witness what happened during incident. Staff #2 stated that the Licensee showed video footage from incident later that evening so staff could see what happened.
...................................................Report continues 1 of 4 Pages...........................................................
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: UNITED FAITH COMMUNITY DAY CARE CENTER
FACILITY NUMBER: 191605376
VISIT DATE: 06/25/2024
NARRATIVE
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LPA Dunlap requested from Licensee staff files, children's files, parent handbook, and incident reports regarding child. Licensee provided staff files, children files, and incident report(s).
Licensee emailed LPA White a copy of electronic parent handbook.

LPA Dunlap reviewed children's file from UIR and observed there was only one incident report/ouch report regarding any incidents with child.

LPA Dunlap reviewed children's files and observed the following documents missing and/or missing information
  • LIC 627
  • LIC701 (physician report not filled out)
  • LIC995
  • LIC613A
  • Receipt of Parent Handbook
  • Admission Agreement

LPA Dunlap reviewed staff and observed the following documents missing and/or missing information
  • LIC, 501
  • LIC 508
  • LIC 503
  • LIC 9108

LPA Dunlap reviewed staff files and observed that there was no licensing paperwork for Staff #3.

At 11:38am LPA Dunlap and White went with Licensee upstairs to observe the off limits area where sounds of children were coming from. LPA's observed 4 children who are 4 years of age (upstairs in an off limits area), 2 children 5 years of age (upstairs in an off limits area), 5 school-age children ages 8-9 (upstairs in an off limits area), and one infant (upstairs in an off limits area) with Volunteer #1. Licensee stated that the children were a part of a private school run by the church.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: UNITED FAITH COMMUNITY DAY CARE CENTER
FACILITY NUMBER: 191605376
VISIT DATE: 06/25/2024
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At 11:54 a.m. LPA White observed the infant that was in the off limits area upstairs being picked up by parent. Licensee states that it was her grandchild that was picked up. LPA White asked Licensee about documentation being provided to Child Care Licensing stating that there is a private school operating at the same address of the day care. Licensee states that she was not aware of the department requirement to be notified when operating a private school. Licensee further states that she has proof of applying for the affidavit to the Department of Education. Licensee emailed LPA White a copy of the affidavit, but it did not provide proof that they were approved to operate as a Private school at the time of inspection. This poses a potential risk to the health and safety of children in care. This also means that the facility is operating outside of the terms of the license which poses a potential risk to the health and safety of the children in care.

At 12:30 p.m., LPA White searched on LIS and Guardian System to run Staff #3 driver's license number to determine if Staff #3 is associated with facility. LPA did not observe Staff #3 to be associated to the facility. LPA White informed licensee, and Licensee provided proof of fingerprinting completion for Staff #3. LPA White was able to locate Staff #3 in Guardian and associate staff member to the facility.

LPA Dunlap contacted Staff #3 via phone at 1:38pm because they were not present at time of inspection. Staff #3 stated that although they were present at the facility, they were upstairs and did not witness the incident of the child being injured.

LPA Dunlap requested to review the vidoe footage from the date of the incident. LIcensee was unable to provide footage due to recycling of limited media storage space.

LPA Dunlap provided consultation to Licensee on best practices in storing children's files, and staff files. LPA Dunlap offered technical assistance with department documentation of required areas of inspection for upcoming annual.

LPA Dunlap requested the following documentation to be emailed no later than 6/26/2024:
  • Facility Roster
  • Personnel Roster
LPA Dunlap explained the department regulation for having these documents available at the time of inspection, and the potential risk posed to the health and safety of the children in care.
................................................................Report Continues 3 of 4 Pages...................................................
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: UNITED FAITH COMMUNITY DAY CARE CENTER
FACILITY NUMBER: 191605376
VISIT DATE: 06/25/2024
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Based on observations, interviews, and file review the following deficiencies will be cited according to California Title 22 on the attached 809D. Deficiencies cited need to be cleared on or before the plan of correction due date specified.

A notice of site visit was given and must remain posted for 30 days. Failure to post will result in a civil penalty of $100.

Report was reviewed with Licensee Carol Sanders. A copy of the report, notice of site visit, and appeal rights were provided to Licensee Carol Sanders.


......................................................Report Ends 4 of 4 Pages...................................................................
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/25/2024 04:25 PM - It Cannot Be Edited


Created By: Keneisha Dunlap On 06/25/2024 at 03:11 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: UNITED FAITH COMMUNITY DAY CARE CENTER
FACILITY NUMBER: 191605376

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2024
Section Cited
CCR
101161(a)

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A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

The regulation was not met as evidenced by:
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Licensee states that she will provide proof of approval of Private School Affidavit for the 2023/2024 school year on or before the POC date.
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Based on observations, record review, and interviews the licensee did not comply by having 12 children including one infant in an off limits area without documentation on file with department which poses a potential risk to the health and Safety of children 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:Karen Chambers
LICENSING EVALUATOR NAME:Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:
DATE: 06/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/25/2024


LIC809 (FAS) - (06/04)
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