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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191671133
Report Date: 04/08/2022
Date Signed: 04/08/2022 01:52:58 PM

Document Has Been Signed on 04/08/2022 01:52 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: 48CENSUS: 38DATE:
04/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:48 AM
MET WITH:Stephanie Washington & Reshon Moutra TIME COMPLETED:
02:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection on 04/08/22 for the purpose of investigating an incident that was reported to the department on 04/01/22. LPA arrived at the facility at 11:48AM and met with Teacher, Stephanie Washington in Room 402. Twain Child Development Center is part of the Long Beach Unified School District and the Child Development Centers are required to comply to Title 5 ratios of 1:8. In Room 402 upon arrival at 11:48AM LPA observed Teacher Stephanie Washington with 2 other staff with 21 children in Room 402. Staff in Room 402 were providing lunch to the children in care and supervising within their 1:8 ratio.

At 11:52AM LPA entered Room 401 and was met by Staff #4. LPA observed Staff #4 and Staff #5 caring for and providing lunch to 17 preschool children. Room 401 was observed to be out of ratio and exceeded their 1:8 ratio by 1. This poses an immediate health and safety risk to children in care. Staff #4 and #5 were out of ratio until approximately 12:24PM when a parent arrived to pick up a child in Room 401. Staff #1 through #5 were unable to inform LPA as to how long Room 401 was out of ratio. Staff #1 through Staff #5 were under the impression that Staff #6 was present at the facility somewhere in the office.

At 12:18PM LPA interviewed Adult #1 at the facility along with Child #1. At 12:30PM Staff #7 arrived to relieve Staff #1 and provided LPA with a copy of the facility roster.

At 12:34PM, LPA was met by Program Coordinator, Reshon Moutra who was able to confirm the time that Staff #6 departed the facility.

The incident that LPA initially came to investigate occurred on 04/01/22 and it was reported to the Department on 04/01/22, 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 Child #1 sustained an injury while in care. --------Page 1 of 2
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 191671133
VISIT DATE: 04/08/2022
NARRATIVE
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LPA conducted interviews and obtained copies of documentation during the inspection.

Due to insufficient information available at this time, LPA will return on another date and time.

However, due to LPA observing the facility out of ratio on today's date, the following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22.

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 form must be maintained in each child’s file immediately upon receipt from parent.Program Coordinator was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

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. Exit interview was conducted with Reshon Moutra, Program Coordinator, including, but not limited to Provider Rights, Appeal Procedures.

----Page 2 of 2

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/08/2022 01:52 PM - It Cannot Be Edited


Created By: Rita Ramos On 04/08/2022 at 01:26 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: LBUSD-TWAIN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191671133

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/08/2022
Section Cited
CCR
101216.3(c)(1)(C)

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 101216.3(c)(1)(C) Teacher-Child Ratio
Child development programs funded by the California Department of Education and operating under Title 5 ...Title 5 staffing ratios shall apply in such centers...
Preschool (36 months to enrollment in kindergarten) - 1:8 adult-child ratio, 1:24 teacher-child ratio.
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Staff #1 called Program Coordinator during the inspection. Program Coordinator arrived to meet ratio requirments. Program Coordinator went over ratios and staff requirments during the inspection.
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This requirement is not met as evidenced by LPA observing that Staff #4 & #5 were caring for 17 children in Room 402. This poses an immediate health, safety, and personal rights risk to 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:Trevino Cochran
LICENSING EVALUATOR NAME:Rita Ramos
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2022


LIC809 (FAS) - (06/04)
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