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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191671133
Report Date: 05/22/2025
Date Signed: 05/22/2025 03:36:02 PM

Document Has Been Signed on 05/22/2025 03:36 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:LBUSD-TWAIN CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191671133
ADMINISTRATOR/
DIRECTOR:		KELLIE HAUSERFACILITY TYPE:
850
ADDRESS:4666 SUNFIELD AVE.TELEPHONE:
(562) 425-2735
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 25DATE:
05/22/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Coordinating Teacher-Nicole VsalloTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) conducted an unannounced case management inspection at the facility. LPA met with Coordinating Teacher (CT) Nicole Vasallo and advised the reason for the visit was to follow up on the Unusual incident Report (UIR) submitted to the Department on 5/2/25. There were 13 students and 3 staff in room 401 and 12 children with two staff in Room 402.

On 5/15/25 LPA conducted a visit to the facility to follow up on the UIR. LPA conducted staff interviews and collected pertinent information. The incident occurred on 5/1/25. The incident involved Child 1 who was found by Staff 1 and their parent unsupervised on the playground.
Per interviews conducted on 5/15/25, the classroom (room 401 ) was playing inside in the afternoon when the incident occurred. Staff 1 observed Child 1 inside the classroom playing near the art area. Other staff in the classroom were assisting other children when Child 1's parent arrived at the classroom and asked for Child 1. That is when staff began looking for Child 1 as they believed they were also inside the classroom. Per interviews, it was at most 5 minutes from the time Child 1 was seen in the art area and when their parent arrived. Staff assisted the parent by checking all areas of the classroom, the restroom and the classroom next door. As Staff 2 was walking with parent to the next classroom, they spotted Child 1 outside on the play structure. Staff 1 was walking outside from the restroom at the same time. Per Staff interviews, they were unsure if Child 1 had left the classroom from the main door that leads outside or from the restroom which also leads outside. Per interviews, child was found to be safe and not in distress.
Per CT, the facility has installed door alarms on all doors in the classrooms that lead outside to the playground and they are actively scanning for all children throughout the day.

Based on interviews and record review the above incident is being cited according to CCR Title 22. A type A citation is being issued for regulation 101229 Responsibility for Providing Care and Supervision.
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NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: LBUSD-TWAIN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191671133
VISIT DATE: 05/22/2025
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LPA informed Facility Representative that this report dated 5/22/25 documents one (1) type A citation which will be posted for 30 consecutive days as there are immediate risks to the safety of children in care.

LPA also informed Facility Representative to provide a copy of this licensing report dated 5/22/25 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the facility representative Nicole Vasallo -Coordinating Teacher.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/22/2025 03:36 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 05/22/2025 at 03:14 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: 05/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/23/2025
Section Cited
CCR
101229(a)(1)

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101229 (a)The licensee shall provide care and supervision as necessary to meet the children's needs(1)No child shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was no met as evidenced by
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The facility has installed alarms on all classroom doors that lead to the playground and have conducted a training regarding active supervision. Agenda for training was provided during this inspection.
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Based on record review and interview the facility did not comply with the section cited above when Child 1 was found outside with no supervision. This poses an immediate threat to the 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.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Jeanette Estrada
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2025


LIC809 (FAS) - (06/04)
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