197402656-9-22-2022-30-CC-LJCS-CJHRMP-20220922130905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197402656
Report Date: 09/22/2022
Date Signed: 09/22/2022 01:09:12 PM

Document Has Been Signed on 09/22/2022 01:09 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:	197402656
ADMINISTRATOR:	NEGIN ZOMORODI		FACILITY TYPE:	830
ADDRESS:	3233 S SEPULVEDA BLVD.		TELEPHONE:	(310) 915-5827
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY:	25	CENSUS: 12	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 09/22/2022 Licensing Program Analysts (LPA) Lillian Casillas arrived at the facility to conduct an annual random inspection at the infant center. LPA met with Director, Negin Zomorodi, who guided LPA on a tour of the facility. Day and hours of operation are Monday through Friday, 7:30am to 5:30pm. LPA observed 12 infants being supervised by 6 staff during this inspection. LPA observed care being provided for infants in 2 classrooms. LPA observed age appropriate toys for infant children. Toys were found to be safe, does not have sharp points, edges, splinters or made of small parts that can be pulled off and swallowed. LPA observed the combination of toys provide manipulative skills and encourage auditory, visual and tactile stimulation. LPA observed smoke/carbon monoxide detectors in each classroom.LPA observed kitchenettes in each classroom with sinks and refrigerators to store infants bottles or food labeled individually. Facility participates in a meal program through Title IV. The following infant to adult ratios were observed: Classroom 1 Sea Turtles (8 weeks to 15 months): 5 infants, 3 teachers Classroom 2 Sea Horses (16 months to 24 months): 7 infants, 3 teachers LPA observed 1 bathroom in Classroom 2 for the infants who are potty training. Each classroom has 1 diaper changing table and 1 corresponding sink. Changing tables have at least a 1-inch-thick padding covered with washable vinyl or plastic. Sides are raised to a minimum of 3 inches. Changing table is within an arm's reach of a sink. There is a minimum of 1 potty chair or toilet for every 5 infants currently toilet training. There is a working smoke/carbon monoxide detector in each classroom. LPA observed sufficient infant cribs and mats in each classroom. Infant cribs were inspected for good [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: 197402656
	VISIT DATE: 09/22/2022

NARRATIVE

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condition, appropriate storage and cleanliness. Each crib, mat or cot is occupied by only one infant at time and cribs are kept free from all loose articles including blankets and pillows and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. LPA observed "Safe Sleep Nap Time Check" forms for each infant. Staff physically checks on sleeping infants every fifteen minutes and documents any signs of distress, which includes but is not limited to: flushed skin color, increase in body temperature, restlessness and labored breathing. Documentation for infants up to 12 months includes sleeping position if it is other than on their back. Napping sheets are washed daily in a laundry area located at the lobby of the Center.

LPA observed 1 outdoor play area dedicated to infants with age-appropriate equipment in safe condition. In the outdoor play area, LPA observed First Aid kit is secured to the wall as well the 2A10:BC is located in the director's office (serviced 8/8/2022).

Capacity and limitations as specified on the license are being maintained. There is a ratio of one teacher supervising no more than four infants in care. The name of the child care center director or fully-qualified teacher designated to act in the director’s absence has been reported to the Department. Parents use a QR code to sign their child in/out of the facility and their full legal signature and record the time of day appears on record.

LPA reviewed a sample of 10 children’s files and observed files were complete, including the Infant Needs and Services Plan and the LIC 9227 Individual Infant Sleeping Plan. LPA reviewed a sample of 6 staff files and observed files were complete. All staff are trained in Pediatric First-Aid/CPR and Mandated Reporter training is current.

LPA verified that all adults present in the facility have obtained criminal record clearances and are associated to the facility. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. 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.

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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: 197402656
	VISIT DATE: 09/22/2022

NARRATIVE

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