197402655-9-22-2022-30-CC-LJCS-CJHRM2-20220922130800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197402655
Report Date: 09/22/2022
Date Signed: 09/22/2022 01:08:09 PM

Document Has Been Signed on 09/22/2022 01:08 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	UCLA EARLY CARE & EDUC. UNI. VILLAGE C.C.C.		FACILITY NUMBER:	197402655
ADMINISTRATOR:	NEGIN ZOMORODI		FACILITY TYPE:	850
ADDRESS:	3233 S SEPULVEDA BLVD		TELEPHONE:	(310) 915-5827
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY:	90	CENSUS: 51	DATE:	09/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Negin Zomorodi		TIME COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 9/22/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced annual inspection at the preschool. LPA met with Director, Negin Zomordo, who guided LPA on a tour of the facility. Day and hours of operation are Monday through Friday, 7:30am to 5:30pm. The facility has 4 classrooms: RM 1: Seals (2 year olds), RM 2: Sea Otters (3 year olds), RM 3: Sharks (4 year olds) and RM 4: Dolphins (older 4 year olds). This is a Title 5 facility. LPA observed 51 children in care and 13 teachers present during this inspection. LPA reviewed the sign in/out sheet to verify the census. The following ratios were observed: RM 1 Seals: 16 preschool children with 4 teachers RM 2 Sea Otters: 16 preschool children with 3 teachers RM 3 Sharks: 16 preschool children with 3 teachers RM 4 Dolphins: 16 preschool children with 3 teachers A walk-through of the classrooms was conducted, and classrooms were found to be clean and free from any potential hazards. Furniture was found to be in good repair and age appropriate. There is adequate heating, lighting and ventilation. LPA observed smoke/carbon monoxide detectors in each classroom. Drinking water is readily available in each classroom, and children bring their own water bottles. LPA observed classroom space to include dramatic play, arts/crafts, reading, individual cubbies for storage and learning activities. LPA observed bathrooms in each classroom with two children's toilets and two sinks. Bathrooms were found to be clean. There are sufficient toilets and sinks to accommodate the facility’s capacity. [CONTINUE ON PAGE 2]

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J Casillas	TELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: UCLA EARLY CARE & EDUC. UNI. VILLAGE C.C.C.	FACILITY NUMBER: 197402655
	VISIT DATE: 09/22/2022

NARRATIVE

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LPA observed kitchenettes in each classroom with 1 sink and refrigerator. Meals are provided through Title IV and food is prepared in the kitchen located in the main lobby area. This facility provides snacks and lunch. Menus are posted and allergy lists are posted in each classroom. LPA also observed laundry area in the main lobby where sheets are washed weekly. The director's office is the designated Isolation area.

LPA observed two large outdoor play areas equipped with age-appropriate play equipment that is in safe condition. Outdoor play area 1 is dedicated to two years olds. Outdoor play area 2 is dedicated to 3 and 4 year olds. LPA observed sinks in each outdoor area. The surface of the outdoor activity space is maintained in safe condition and is free of hazards.

LPA observed 2A10:BC fire extinguishers (serviced 8/8/2022) located outside each classroom in the outdoor play area. LPA also observed first-aid kits secured to the walls of the outdoor play area. Facility was observed to be operating within the conditions, limitations, and capacity specified on the license.

LPA reviewed a sample of all staff files present to be complete, including documentation of education credits. All staff are trained in CPR and Pediatric First Aid and Mandated Reporter training is current. LPA reviewed a sample of 10 children’s files and observed files were complete.

LPA verified that all adults present in the facility have obtained criminal record clearances and are associated to the facility. Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

Incidental Medical Services (IMS) are not currently being provided. Director is aware that an IMS plan is

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SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J Casillas	TELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: UCLA EARLY CARE & EDUC. UNI. VILLAGE C.C.C.	FACILITY NUMBER: 197402655
	VISIT DATE: 09/22/2022

NARRATIVE

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required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Exit interview conducted and report was reviewed with Director, Negin Zomorodi.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J Casillas	TELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC809 (FAS) - (06/04)

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