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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019682
Report Date: 07/13/2022
Date Signed: 07/13/2022 04:11:03 PM

Document Has Been Signed on 07/13/2022 04:11 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:BELGER FAMILY CHILD CAREFACILITY NUMBER:
198019682
ADMINISTRATOR:OLIVIA ADDIE BELGERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 423-5017
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
07/13/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Assistant - Belen CollantesTIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Randy Derraco conducted a case management visit to the above mentioned facility to observed corrections to deficiencies cited on 06/21/22. LPA met with assistant Belen Collantes who guided analyst on a tour of the facility. LPA observed 8 children in care. LPA observed S2 arriving to the facility at 03:17PM. At 3:30PM, LPA observed 2 children leaving the facility. LPA observed Licensee, Olivia Belger, arriving to the facility at 4:00PM. Licensee continued inspection with LPA.

LPA reviewed children's files and observed that immunization records and emergency identification form (LIC 700) was available for each child present at the facility. LPA reviewed staff files and observed that immunization records were available for each assistant in attendance during inspection. LPA reviewed facility roster and observed that LIC 9040 is current and up to date. Letters for Deficiency Cited Cleared were provided to licensee

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

Exit interview conducted and report was reviewed with the licensee Olivia Belger

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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