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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601954
Report Date: 07/21/2023
Date Signed: 07/21/2023 03:57:39 PM


Document Has Been Signed on 07/21/2023 03:57 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:UCLA EARLY CARE AND EDUCATION-INFANTSFACILITY NUMBER:
191601954
ADMINISTRATOR:AMY AGNEWFACILITY TYPE:
830
ADDRESS:101 S. BELLAGIO DR.TELEPHONE:
(310) 825-5086
CITY:LOS ANGELESSTATE: CAZIP CODE:
90095
CAPACITY:60CENSUS: 21DATE:
07/21/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Rosaura Castillo, Center CoordinatorTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced case management inspection on 7/21/2023. LPA arrived to the facility at 12:09pm and met Rosaura Castillo, Center Coordinator, who guided analyst on a tour of the facility. LPA observed 21 children with 8 staff upon arrival.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1,2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test.

On 10/27/2022 LPA Sabrina Martinez, conducted a visit to the facility to address an Action Lead Exceedance (ALE) found in faucet “I”. Faucet “I” was tested on 9/22/2022 and resulted with a 8.3 ppb on 10/04/2022. The facility was cited. On 11/28/2023, Director stated that the exceedance would be corrected by installing a replacement of the localized fixture to include the angle stops, supply lines, replace the hose bib and have the outlet re-tested by the same certified external water sampler. The new re-test yielded an exceedance of 5.7 ppb.

Due to the facility continuing to have an exceedance in faucet “I”. The facility decided to cap off “I” faucet outlet and cease usage. Facility will provide a written stament attesting that the Child Care Center has not used and will not use outlet "I", for drinking water or food preparation accompanied by a labeled facility map (LIC 999) identifying all water outlets located at the facility. Facility will provide documentation by COB 07/24/2023.

There were no deficiencies cited during today’s inspection.

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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) -301-3061
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: UCLA EARLY CARE AND EDUCATION-INFANTS
FACILITY NUMBER: 191601954
VISIT DATE: 07/21/2023
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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. Exit interview was conducted with Rosaura Castillo, Center Coordinator, including, but not limited to Provider Rights, Appeal Procedures

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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) -301-3061
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
LIC809 (FAS) - (06/04)
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