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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005596
Report Date: 09/01/2022
Date Signed: 09/01/2022 02:31:08 PM

Document Has Been Signed on 09/01/2022 02:31 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:BILODEAU FAMILY CHILD CAREFACILITY NUMBER:
198005596
ADMINISTRATOR:BILODEAU,LAURA MAJFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 243-2398
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
09/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:Maj BilodeauTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management Incident inspection. This inspection is regarding injury incident to child #1 that took place on August 29, 2022. Licensing Program Analyst met with Licensee Maj Bilodeau and cleared assistant providing care for 11 children.

Licensee Bilodeau guided LPA to the area where child #1 was injured. LPA observed the area with baby gate barrier where child was injured. LPA observed the area to have age appropriate equipment and the equipment has no structural damage. The room appeared to be in normal safe good condition. The Licensee indicated she was approximately eight ft away and came right away when the was injured. Staff #1 was in another area of the home and did not witness the injury. Child #1 provided a re-enactment in which the child described a trip over a baby gate floor rail, falling on a child sized chair and sustaining a cut on the chin). Licensee and Staff #1 indicated there were 11 children at the time which is in ratio.

Post injury, staff immediately conducted first aid and contacted parents. The child was taken to the hospital for medical treatment and returned to the childcare the next day with no medical restrictions. Staff followed the required protocol in terms of first aid and "reporting requirements" as the facility was informed of the doctor visit after hours on 8/29/22 and reported to Child Care Licensing within next business day on 9/1/2022. The Information provided matches the incident report. Licensee Bilodeau this is the only injury that has happened at the facility in two decades. Based on interviews and observations there were no violations of Title 22 requirements.

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 Licensee Maj Bilodeau.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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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