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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670974
Report Date: 04/06/2023
Date Signed: 04/06/2023 03:44:22 PM


Document Has Been Signed on 04/06/2023 03:44 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:LBUSD-MANN CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191670974
ADMINISTRATOR:ROBBIE WADELLFACILITY TYPE:
850
ADDRESS:3215 E VISTA AVETELEPHONE:
(562) 439-7896
CITY:LONG BEACHSTATE: CAZIP CODE:
90803
CAPACITY:48CENSUS: 20DATE:
04/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Nancy Perez, Coordinating TeacherTIME COMPLETED:
04:15 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
On 04/06/2023 at 2:00 PM Licensing Program Analysts (LPAs) Katrina Chicote and Franchesca White conducted an Unannounced Case Management inspection to follow up on an incident that was reported to the Department on 03/31/2023. Upon arrival, LPAs met with Nancy Perez, Coordinating Teacher, who provided LPAs a tour of the facility inside and outside. Census taken.

On 03/31/2023, an unusual incident report was made to The Department regarding an incident that involved child leaving the facility. The facility reported this incident to the Department within the required 24 hours and submitted a written report within seven days.

During this investigation LPAs interviewed staff (S1, S2, and S3) and child involved in incident (C1). Staff interviews consistently state that they observed child leave facility. S2 states she was unable to leave classroom to stop child from leaving and called for S3, who was on lunch break, to run after C1. S3 states he had full visual supervision of C1 at all times, though per S3, C1 was able to walk down the sidewalk and around the corner. LPAs followed the route where C1 walked from leaving classroom to corner of street during inspection.

Based on the interviews conducted and information obtained, LPAs determined there was a lack of supervision that resulted in the child being able to leave the facility which poses an immediate risk to the health and safety of the children in care. Per CT and Program Coordinator, they have updated their supervision guidance to have supervision on all exits in classroom, close classroom door, and have put in work order to install chime to front door of lobby. Teachers also provided classroom lesson to children in regards to safety and staying with the teachers at all times.

Report Continues - Page 1 of 2
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LBUSD-MANN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191670974
VISIT DATE: 04/06/2023
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
26
27
28
29
30
31
32
Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Nancy Perez.


Report Ends - Page 2 of 2
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/06/2023 03:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: LBUSD-MANN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191670974

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/06/2023
Section Cited

1
2
3
4
5
6
7
101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care.. supervision as necessary to meet the children's needs... (1) No child(ren) shall be left without the supervision of a teacher at any time,... visual supervision.
This regulation was not met as evidenced by:
1
2
3
4
5
6
7
Licensee states they have created plan of action which includes ensuring doors are closed in classroom, staff positioning, and installation of door chime to front door. Teacher will aso provide lesson to students. Licensee will provide action plan with staff signatures by POC date.
8
9
10
11
12
13
14
Based on LPAs interviews and observations, the Licensee did not have full supervision including visual supervision of C1 when he left the facility and was able to walk onto the sidewalk. This is an immediate health, safety, and personal rights 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 ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3