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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002668
Report Date: 12/03/2024
Date Signed: 12/03/2024 02:49:48 PM

Document Has Been Signed on 12/03/2024 02:49 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-WILLARD CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198002668
ADMINISTRATOR/
DIRECTOR:
RESHON MOUTRAFACILITY TYPE:
850
ADDRESS:1055 FREEMAN AVENUETELEPHONE:
(562) 987-1926
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY: 47TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
12/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Coordinating Teacher Tiffany Sanchez TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Jeanette Estrada and Keneisha Dunlap conducted an unannounced visit at the facility and met with Coordinating Teacher (CT) Tiffany Sanchez. LPAs explained to the CT that the reason for the visit is to follow up on an unusual incident reported to the Department on 11/6/24. During today's visit LPAs observed 10 children and three staff present.

The Department received an Unusual Incident Report (UIR) from the facility on 11/6/24. The incident was documented to have occurred on 11/4/24. Per the UIR, Child 1 attended the facility for the first time on 11/4/24. On 11/5/24 the facility was notified by Child 1's parent about an alleged incident that occurred during lunchtime according to Child 1. The facility has collected statements from staff present on 11/4/24.

No citations are being issued during today's visit. Further investigation will be completed by the Department.

Exit interview conducted with CT, Tiffany Sanchez. Notice of Site Visit and a copy of this report were provided to Facility Representative.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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