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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191671133
Report Date: 04/19/2022
Date Signed: 04/19/2022 01:07:28 PM

Document Has Been Signed on 04/19/2022 01:07 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: 52CENSUS: 24DATE:
04/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Kellie Hauser, Coordinating Teacher TIME COMPLETED:
01:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection on 04/19/22 for the purpose of investigating an incident that was reported to the department on 04/01/22. LPA arrived at the facility at 9:10AM and met with Coordinating Teacher, Kellie Hauser, who provided a tour of the facility. There were 26 children with 6 staff present upon arrival. LPA was later met by Program Coordinator, Lindsey Evans. This facility is located within Mark Twain Elementary school in the city of Long Beach.

LPA initially came to investigate the incident on 04/08/22. The incident 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.

During the investigation LPA conducted interviews with children, staff, and parents. LPA took pictures and obtained copies of documentation.

Based on the interviews conducted with Staff #1, #3, and #4, staff disclosed that meals are served to children in food trays prior to staff assisting children with opening any sealed packaged hot food. It was determined that on 04/01/22 children were served their food tray and Child #2 singularly opened a hot sealed pizza package that resulted in spillage onto Child #1. Child #1 sustained a burn injury due to the spillage. Although the incident was an accident by Child #2, the facility served the hot food meal to the children prior to staff assisting in opening and cooling the sealed hot food packages making it unsafe for preschool children.

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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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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Document Has Been Signed on 04/19/2022 01:07 PM - It Cannot Be Edited


Created By: Rita Ramos On 04/19/2022 at 12:21 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: 04/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2022
Section Cited
CCR
101227(a)(1)

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101227(a)(1) Food Services

All food shall be selected, stored, prepared and served in a safe and healthful manner.

This requirement is not met as evidenced by facility serving hot food prior to staff assisiting
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Per Coordinating Teacher, all staff will ensure that hot food packages are opened before they come into the classrooms. A staff training will be conducted and food service will be discussed and staff meeting notes signed by all staff will be submitted by POC due date of 04/26/22.
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in opening or cooling the hot food. Child #2 singulary opened their hot food package causing spillage onto Child #1. Child #1 sustained a burn and although it was accidental the food was served to children prior to staff assisting in cooling or opening the food packages which poses a potential health and safety 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: 04/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022


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: 04/19/2022
NARRATIVE
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Therefore, the following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22.

LPA also issued a Technical Violation due to the facility not reporting that meals are currently being delivered and served at the facility. This facility has a waiver to walk children to the cafeteria at Mark Twain Elementary School in which meals are usually served by cafeteria district staff. The facility did not report that due to Measure E, the elementary school cafeteria is under construction.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days.

Exit interview was conducted with Kellie Hauser, Coordinating Teacher, including, but not limited to Provider Rights, Appeal Procedures.

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

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC809 (FAS) - (06/04)
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