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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197410448
Report Date: 11/01/2022
Date Signed: 11/01/2022 12:15:31 PM


Document Has Been Signed on 11/01/2022 12:15 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 DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG.FACILITY NUMBER:
197410448
ADMINISTRATOR:MARIA PATRICE WINNFACILITY TYPE:
830
ADDRESS:320 NO. CHARLES E. YOUNG DR.TELEPHONE:
(310) 206-0633
CITY:LOS ANGELESSTATE: CAZIP CODE:
90095
CAPACITY:20CENSUS: 17DATE:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Patrice Winn, DirectorTIME COMPLETED:
12:30 PM
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On 11/1/2022, Licensing Program Analyst (LPA) Adrian Risher conducted an unannounced Annual Required Inspection for the infant license. LPA met with Director, Patrice Winn, and toured the facility indoors and outdoors. Days and hours of operation are Monday to Friday 7:30-5:30pm. LPA observed 17 infants with 7 staff. LPA confirmed the facility phone number:310-206-0633.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. All poisons are kept in a locked storage area. LPA observed furniture and equipment are in good condition. LPA inspected the bathrooms in each classroom and observed all equipment operating properly. LPA inspected the kitchen in both classrooms. The food stored in the classrooms were labeled for each child.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
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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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 DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG.
FACILITY NUMBER: 197410448
VISIT DATE: 11/01/2022
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Drinking water is available both indoors and outdoors. LPA observed age-appropriate play equipment in the outside play area. LPA tested the carbon monoxide detectors and smoke detectors during inspection. LPA observed fire extinguishers and first aid kits in each classroom.

LPA completed file reviews for children and staff. Children and staff files were complete. Infants have proper infant sleeping plans as well as needs & services plans in their files. LPA observed more than one staff with current cpr and pediatric first aid certification. LPA observed proper sign in/out documentation. Director stated the center uses Brightwheel app for sign in /out purposes. Menus are posted in advance where an authorized representative can view them.

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. Staff physically checks on sleeping infants every fifteen minutes and documents any signs of distress.

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Facility representative 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

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG.
FACILITY NUMBER: 197410448
VISIT DATE: 11/01/2022
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LPA discussed the safe sleep regulations with facility representativeand discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Patrice Winn

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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