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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603200
Report Date: 11/15/2022
Date Signed: 11/15/2022 01:50:28 PM

Document Has Been Signed on 11/15/2022 01:50 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:FIRST BAPTIST CHURCH OF LAKEWOOD PRESCHOOLFACILITY NUMBER:
191603200
ADMINISTRATOR:MELISSA CLAYTONFACILITY TYPE:
850
ADDRESS:5336 ARBOR ROADTELEPHONE:
(562) 420-2833
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 58DATE:
11/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Melissa ClaytonTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management Incident inspection. This inspection is regarding an incident that took place on November 1, 2022. Licensing Program Analyst met with Director Melissa Clayton who providing information and assistance for the inspection.

During the course of today's inspection LPA conducted an interview with staff #1 and child #1. LPA also observed a video recording. Based on interviews with children and staff, there were no verbal corroborating disclosures that substantiate a Title 22 violation. In addition, there were no written corroborating disclosures that would substantiate that a Title 22 violation took place at this time.

Note: Director Clayton reported the incident to Child Care Licensing (CCL) in a timely manner (within 24 hours) and submitted a written report in a timely manner (within 7 days).

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. Exit interview was conducted with Director Melissa Clayton.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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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