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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010585
Report Date: 08/11/2021
Date Signed: 08/11/2021 01:11:17 PM

Document Has Been Signed on 08/11/2021 01:11 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:LONG BEACH COMMUNITY IMPROVEMENT LEAGUEFACILITY NUMBER:
198010585
ADMINISTRATOR:LAURA SIDNEYFACILITY TYPE:
840
ADDRESS:2399 CALIFORNIA AVENUE,SUITE ATELEPHONE:
(562) 951-3500
CITY:SIGNAL HILLSTATE: CAZIP CODE:
90755
CAPACITY: 29TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
08/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Latasha Haley-Lead TeacherTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced random inspection at 11:30am. LPA met with designated facility Lead Teacher, Latasha Haley, who guided LPA on a tour of the facility. This is a school age program licensed for 29 children which operates Monday – Friday from 7:00 AM – 6:00 PM.

All areas identified on the facility sketch were inspected. Upon arrival, LPA observed five children with one staff. Teacher/child ratios were observed to be in accordance with Title 22 school age regulations. The facility is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times.

Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. Storage for medication was inspected to ensure that medications are in a safe place inaccessible to children. All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, the office is used as an isolation area. There are chairs in the office. Parents are contacted immediately when children are determined to be ill.

Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides breakfast, lunch and PM snack. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and LPA inspected that any contaminated food is discarded immediately. There is drinking water available in all indoor classrooms and there are drinking fountains outdoors where children fill up their cups. All storage containers for solid waste, including moveable bins have tight fitting covers on and are in good repair.
Report continues- Page 1 of 3
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2021
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: LONG BEACH COMMUNITY IMPROVEMENT LEAGUE
FACILITY NUMBER: 198010585
VISIT DATE: 08/11/2021
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Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Storage areas for poisons are locked. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The facility takes measures to keep the facility free of flies, other insects and rodents.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit.

Areas around and/or under climbing equipment have cushioning material to absorb a fall. Director states there are no weapons or firearms on the premises.

Sign in and out sheets were reviewed to ensure that procedures are in accordance with Title 22 requirements. Staff Records were reviewed to ensure that a health screening report is on file. Children’s Records were reviewed. (Name, address, telephone of child’s authorized representative, Medical Assessment.) for completeness; Inspection of required forms was made and documented on the LIC 857.

LPA also reviewed staff records. 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. Staff present did have proof against TB, measles, pertussis, and influenza. All staff have been given on the job training sanitation principles, housekeeping, including universal health precautions.

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

LPA also issued the Review of Staff records (LIC 859) to the Supervisor during this inspection. The LIC 857 and the LIC 859 documents the staff and children’s files that were reviewed during this inspection.


Report continues- Page 2 of 3
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
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: LONG BEACH COMMUNITY IMPROVEMENT LEAGUE
FACILITY NUMBER: 198010585
VISIT DATE: 08/11/2021
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview was conducted with Executive Director Dr. Khaleghi. The Executive Director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.



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.

Report ends- Page 3 of 3
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3