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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400548
Report Date: 11/02/2023
Date Signed: 11/02/2023 03:39:15 PM

Document Has Been Signed on 11/02/2023 03:39 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:LAUNCH PAD LEARNING NLBFACILITY NUMBER:
198400548
ADMINISTRATOR:CLAUDIA CEBALLOSFACILITY TYPE:
830
ADDRESS:6951 OBISPO AVETELEPHONE:
(562) 633-5700
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 27DATE:
11/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Director - Claudia CeballosTIME COMPLETED:
02:20 PM
NARRATIVE
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Licensing program analyst (LPA) conducted a case management visit on 11/02/23 to the above mentioned facility. LPA arrived at the facility at 9:45 AM and was met by Director, Claudia Ceballos, who guided analyst on a tour of the facility. LPA began case management visit at 1:50 PM. During the inspection, LPA observed 27 children in care, and 9 adults caring for the children. The facility was observed to be clean and in good repair.

The purpose of this visit is to issue a citation for not reporting an Unusual Incident that occurred from May 2023 through September 2023. Individuals interviewed state that Director was informed that S1 was holding children down with his legs during nap time. Individuals interviewed also state that observations were made of S1 and reported to both the Director and the Owner. LPA advised Director that a citation under California Code of Regulation 101212(d)(1)(C) will be issued.

During the inspection, LPA reviewed the process of reporting an unusual incident to the Department. LPA confirmed with the Director, that the Department will be notified by the next business day during business hours by either telephone or fax. A written report of the unusual incident will need to be completed on state form LIC624 within 7 days of reporting the incident by phone or fax.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director Claudia Ceballos

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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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Document Has Been Signed on 11/02/2023 03:39 PM - It Cannot Be Edited


Created By: Randy Derraco On 11/02/2023 at 02:14 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: LAUNCH PAD LEARNING NLB
FACILITY NUMBER: 198400548

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2023
Section Cited
CCR
101212(d)(1)(C)

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101212 Reporting Requirements(d)...a report shall be made to the Department by telephone or fax within the Department's next working day...(1) events shall include the follow:(C) any unusual incident...This requirement is not met as evidenced by:
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Director states she will complete a declaration (LIC855) indicating that she has reviewed and understands the Reporting Requirement under CCR section 101212
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Based on observation, interview and record review, the director did not report an unusal incident by telephone or fax which poses a potential health, safety and/or personal rights risk to persons 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.
SUPERVISOR'S NAME:Denise Gibbs
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023


LIC809 (FAS) - (06/04)
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