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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 03:24:18 PM

Document Has Been Signed on 10/24/2022 03:24 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:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Stephanie Stephens, Coordinating Teacher (CT)TIME COMPLETED:
04:00 PM
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On 10/24/2022 Licensing Program Analyst (LPA) Katrina Chicote conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 10/14/2022. LPA singularly toured indoor and outdoor of facility. Upon arrival, LPA met with Stephanie Stephens, Coordinating Teacher and was notified of reason forf the visit. LPA observed 13 children and four teachers at time of inspection.

On 10/17/2022, an incident was reported to the department via email where a child, from AM program, was playing on monkey bars and missed the second bar attempting to swing onto it. Child fell on her right arm. and first aid was immediately provided and child was taken to Nurse's Office where she was picked up by parent shortly after. The facility reported this incident to the Department within the required 24 hours and written report received within 7 days.

During this inspection LPA interviewed staff who observed incident. Coordinating Teacher informed licensing that they have closed the monkey bars from use at this time and will re-evaluate if they will open up for children's use at a later time. LPA interviewed teacher who stated he observed the incident occur and discussed supervision of the play yard. Per staff, they have been in communication with the parent and child has returned to facility as of 10/21/2022. LPA observed the monkey bars where the incident took place. LPA obtained and reviewed documentation. Based on the information obtained and LPA observation of the play area, LPA determined there was adequate supervision provided the day of the incident.

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

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview conducted with the Stephanie Stephens.
Report Ends - Page 1 of 1
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)
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