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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416358
Report Date: 10/26/2022
Date Signed: 10/26/2022 03:26:11 PM


Document Has Been Signed on 10/26/2022 03:26 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:NU BUILDING BLOCKS DAY CARE CENTER-SCH.AGE.FACILITY NUMBER:
197416358
ADMINISTRATOR:SOLOMON, CHERYLFACILITY TYPE:
840
ADDRESS:2313 W JEFFERSON BLVDTELEPHONE:
(323) 732-5439
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY:18CENSUS: 0DATE:
10/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Larry Solomon, LicenseeTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPA) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 10/26/22 at 9:00 AM. LPA met with Larry and Paige Solomon, Facility Representative (FR) who guided analysts on a tour of the facility.

This is a School-Age program which consists of one classroom located upstairs from the preschool component. School Age operation hours are Monday-Friday 3pm-6pm and 12:45pm-6pm on early dismissal days. Additional care is provided on evening and weekends when needed. There were no School Age children present when LPA arrived.

All individuals present have obtained a criminal record clearance.

School Age has their own entrance and walkway to get upstairs and do not commingle with preschool children. LPA toured school age classroom. LPA observed a chair with a ripped seat cushion and a floor carpet with crumbs and other debris. FR threw away the chair and rug. There are age appropriate material for School-Age children. Water is made readily available via water jugs and cups in the classroom. Per FR, there are currently no children with medication at the facility. Children have cubbies to store personal belongings. First aid kits is located in the office area.

LPA toured the School Age restrooms. LPA observed two restrooms with one toilet and one sink each. Restrooms are designated one for boys and one for girls. LPA observed that the sink and toilet in the boys restroom do not work and there is an out of order sign on the door. Per FR there are 15 School Age children currently enrolled. This is sufficient to cover current capacity. There is a plan to fix the other restroom. LPA did not observe soap or paper towels in the working restroom for children. During inspection FR cleaned and added soap and paper towels to the restroom.
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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2022
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 4


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: NU BUILDING BLOCKS DAY CARE CENTER-SCH.AGE.
FACILITY NUMBER: 197416358
VISIT DATE: 10/26/2022
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LPA toured the outdoor play yard. There is a waiver on file for shared outdoor space in the preschool yard. Per FR, School Age children do not play on the yard while preschool children are out. LPA observed age appropriate toys and equipment for children. LPA observed required shade and a water jug and cups so children can drink freely.

LPA observed required posted documentation outside of the classrooms, which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, and LIC 613A- Notification of Personal Rights and snak Menu. All documents were observed.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 4/22. All documents were observed. Carbon monoxide detector is wired with facility smoke detector and alarm system.

Parents sign in and out via Bright Wheel an application that can be viewed and printed as needed.

LPA toured the kitchen. Storage containers in the kitchen for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers at 45˚ (F) or less.

Children’s records were reviewed for Licensing Form (LIC) 700 Emergency Card, Immunization Records, LIC 627- Consent for Medical Treatment, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. All documents complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification for at least one staff member on site, LIC 9052- Employee Rights, LIC 501- Personnel Record, LIC 503- Health Screening Report, LIC 508- Criminal Record Statement, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse, Transcripts and current Mandated Reporter Training Certificate. Documents were discussed.

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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: NU BUILDING BLOCKS DAY CARE CENTER-SCH.AGE.
FACILITY NUMBER: 197416358
VISIT DATE: 10/26/2022
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Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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.

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

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

Exit interview conducted and report was reviewed with the Paige Solomon, Licensee .---------------PAGE 3

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/26/2022 03:26 PM - It Cannot Be Edited

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: NU BUILDING BLOCKS DAY CARE CENTER-SCH.AGE.
FACILITY NUMBER: 197416358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(e)(4)
Fixtures, Furniture, Equipment, Equipment and Supplies
(e) Faucets used by children for personal care shall deliver hot water. (4) All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids and/or conveniences shall be provided as needed in centers that serve children with physical disabilities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. SINK AND TOILET IN RESTROOM IS INOPERABLE which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2022
Plan of Correction
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LICENSEE STATES THAT PLUMBER WILL COME AND FIX THE SINK AND TOILET BY POC DATE 11/28/22. SCHOOL AGE CHILDREN HAVE ONE OPERABLE RESTROOM.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4