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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400455
Report Date: 10/24/2022
Date Signed: 10/24/2022 01:51:14 PM

Document Has Been Signed on 10/24/2022 01:51 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 CARVER-CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198400455
ADMINISTRATOR:STEPHANIE STEPHENSFACILITY TYPE:
850
ADDRESS:5335 PAVO STTELEPHONE:
(562) 421-7015
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 24TOTAL ENROLLED CHILDREN: 40CENSUS: 13DATE:
10/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Stephanie Stephens, Coordinating TeacherTIME COMPLETED:
02:00 PM
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An unannounced Required – 1 Year Inspection was conducted on 10/24/2022 at 12:00pm by Licensing Program Analyst (LPA) Katrina Chicote. Facility is currently licensed for a capacity of 24. Licensing staff initially met with Sophia Ruiz, General Ed Teacher and announced purpose of visit. Stephanie Stephens, Coordinating Teacher, arrived at 12:40pm to join inspection. The program currently operates a Collaborative Co-Teacher (CCT) AM program from 8:00am to 11:00am and PM program 12:00pm to 3:00pm, Monday thru Friday. LPA singularly toured the facility of both indoors and outdoors.

At the initial start of the site visit, there is a total census of 13 children and a total census of four teachers present. LPA observed children were transitioning to lunch time upon arrival. Facility is located in RM 1 of Carver Elementary School campus. LPA observed required licensing postings on Parent Board outside of classroom, including waivers for use of restroom, cafeteria, and shared outdoor yard.

Beginning at 12:08pm, furniture and equipment were inspected for age appropriateness and good repair. LPA observed carpets, and child size tables and chairs available for children well maintained. LPA observed learning stations for dramatic play, math, and science with toys well maintained free of loose and sharp parts and a library area available for quiet play. Telephone service, heating, lighting and ventilation were evaluated. There were cubbies observed as storage for children's belongings. Facility offers part time programs only and children do not have nap time at the facility. Availability of drinking water was reviewed. LPA observed water coolers available for children. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. LPA observed bathrooms available in classroom that had two toilets and two sinks, a third sink available outside of the bathroom.

Snack/lunch menus were reviewed. All meals and snacks are provided by the Long Beach Unified School District.. Per CT, AM program provided breakfast and PM program provided lunch which staff picks up from cafeteria. Trash cans used to discard food have tight fitting lids.
Report Continues - Page 1 of 3
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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 CARVER-CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198400455
VISIT DATE: 10/24/2022
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LPA observed first aid kit is kept in classroom above outside sink. At 12:10pm, carbon monoxide detectors were tested and smoke detectors observed present in the facility. Fire extinguishers have been serviced on 07/18/2022. LPA observed disaster drill log available, last drill conducted on 10/18/2022. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Coordinating Teacher states that there are no poisons stored at the facility. At 12:09pm, LPA observed medicine that is stored in classroom for C5 to have required documents and to be stored per Title 22 Regulation requirements.

Beginning at 12:15pm, outdoor equipment was inspected for safety, cushioning material, good repair and age-appropriateness. LPA observed three separate play structures, one with steps and a slide, one structure with just monkey bars, and another with steps, climbing equipment, and monkey bars; all with cushioning material below to absorb fall. LPA Chicote advised that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. The children have access to a water cooler during outside play. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.

Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. Facility uses electronic sign in/out sheets, which LPA observed. Personal Rights of children were observed by LPA.

Beginning at 12:45pm, staff and children’s records were reviewed. Children’s Records were reviewed for completeness. Inspection of required forms was made and documented on the LIC 857. The review of Staff records was documented on the LIC 859.

Staff present did have proof of the AB 1207 Mandated Reporter Training certificate on file and all staff have been given on the-job training sanitation principles, housekeeping, including universal health precautions. LPA observed Pediatric First Aid/CPR expires on 08/12/2023 for S3. LPA did not review confidential staff files during the inspection due to the staff confidential files being stored at the administrative office.All staff and employees have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Long Beach Unified School District.
Report Continues - Page 2 of 3
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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 CARVER-CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198400455
VISIT DATE: 10/24/2022
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The following were discussed with the Coordinating Teacher:
Licensee (or facility representative) was reminded that all adults 18 and over in the facility, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed facility. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed.

Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location. LPA advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 10/24/2022.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.



Exit interview was conducted and report was reviewed with the Facility Representative, Stephanie Stephens.
Report Ends Page 3 of 3
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3