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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191671133
Report Date: 05/18/2022
Date Signed: 05/18/2022 12:05:43 PM

Document Has Been Signed on 05/18/2022 12:05 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:LBUSD-TWAIN CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191671133
ADMINISTRATOR:KELLIE HAUSERFACILITY TYPE:
850
ADDRESS:4666 SUNFIELD AVE.TELEPHONE:
(562) 425-2735
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 64TOTAL ENROLLED CHILDREN: 51CENSUS: 36DATE:
05/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Kellie Hauser, Coordinating Teacher TIME COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection due to an incident that occurred on 05/10/22 at approximately 10:10AM. LPA met with Kellie Hauser, Coordinating Teacher, who guided LPA on a tour of the facility.

There were 36 children and 7 staff present upon arrival.

LPA conducted interviews and obtained documentation during this visit.

The incident that occurred on 05/10/22 was reported to the Department on 05/10/22, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that an incident occurred between Child #1 and Child #2.

Based upon information received from the interviews conducted it was determined that Staff #3 observed the incident. Facility reported the incident to parents/guardians of Child #1 and #2 and provided support, resources and guidance. There is no other information indicating a violation of California Code of Regulations Title 22.

There were no deficiencies cited during today’s inspection.

The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview was conducted with Kellie Hauser, Coordinating Teacher, including, but not limited to Provider Rights and Appeal Procedures.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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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