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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417299
Report Date: 02/10/2023
Date Signed: 02/10/2023 12:27:30 PM


Document Has Been Signed on 02/10/2023 12:27 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 WESTWOOD CHILD CARE CENTERFACILITY NUMBER:
197417299
ADMINISTRATOR:NICOLE FIORELLAFACILITY TYPE:
830
ADDRESS:10861 WEYBURN AVENUE #301TELEPHONE:
3104810664
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY:63CENSUS: 41DATE:
02/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Jennie Lopez, Director TIME COMPLETED:
12:30 PM
NARRATIVE
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On 02/10/2023, Licensing Program Analyst (LPA) Denise Miranda, conducted a Case Management- Deficiencies visit for the purpose of citing for the deficiencies that were observed during the visit on 02/10/2023.

LPA met with Jennie Lopez, Director, who guided LPA of the facility. There were 41 infants in care being supervised by 23 staff.

Facility is licensed for age 0 to 24 months. During the tour, LPA observed that one child over two years old, was present at the infant program. Per Director, stated that this child is in transition, and facility does not have space for him at the preschool program.

While inspecting the classrooms: LPA observed that classroom: A-2, L1, L4 is using the classroom play space as a nap area. LPA informed the Director that the nap area needs to be separate from the indoor play area.

LPA took pictures of the cribs in the nap area of the classrooms A1, L2 and L3 ( to observe that the cribs were placed without providing a walkway and workspace between the cribs.



Facility provided a copy of the sign in and out dated today, per title 22, The person who signs the child in/out shall use his/her full legal signature and shall record the
time of day. Facility was unable to produce a copy of the sign in and out with the
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
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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Document Has Been Signed on 02/10/2023 12:27 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: UCLA WESTWOOD CHILD CARE CENTER
FACILITY NUMBER: 197417299

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/10/2023
Section Cited
CCR
101161(a)

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101161(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement is not met as evidenced by: Based on observation and interview of staff, the licensee did not comply
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LPA observed, when Director contacted the child#1 parents, and informed that child#1 will be move to the preschool program today. Per Director, mother of child agreed and child is attending the preschool program. Director understand about her license lmitation age group.
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with the section cited above in that 1 preschool child wascommingled at the infant program, which poses an immediate health, safety or personal rights risk to persons in care,
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LPA observed child#1, at the outdoor area with the preschool chidlren.

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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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/10/2023 12:27 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: UCLA WESTWOOD CHILD CARE CENTER
FACILITY NUMBER: 197417299

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2023
Section Cited
CCR
101439.1

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101439.1 Infant Care Center Sleeping Equipment. (g) Cribs, mats or cots shall be arranged so as to provide a walkway and work space between the cribs... This requirement is not met as
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Facility will arrange so as to provide a walkway and work space between the cribs. Director will submit photos of classroom Infant .(A1,L2 &L3)

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evidenced by LPA observing on 02/10/2023 that the cribs in Infant Rooms A1, L2, L3 are placed without providing a walkway and workspace between the cribs which poses a potential health, safety, and personal rights to children in care.



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“A” napping area, and will submit via email to LPA Miranda no later than 02/14/2023.

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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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/10/2023 12:27 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: UCLA WESTWOOD CHILD CARE CENTER
FACILITY NUMBER: 197417299

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
02/13/2023
Section Cited
CCR
101229.1

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Sign in and Sign out (a) ...the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain, and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
This requirement is not met as by LPA observing on 02/10/2023
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Per Director, facilty is using a my my bright day app. Facility will contact them, to implement the app for a legal signature or will go bak for sign in/out on paper.
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Director provided a copy of sign in and out dated 02/10/23 and was not indicated on this report, that the person signs the child's in/out shall use his/her full legal signature, which poses an potential health, safety or personal rights risk to persons in care.
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At the meantime, facility will use the paper version of sign-in and out, until faciltiy decide if will have impementation trough the app. A copy of the sign/in and out dated today will submit to LPA no later than 2/13/2023.

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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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/10/2023 12:27 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: UCLA WESTWOOD CHILD CARE CENTER
FACILITY NUMBER: 197417299

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
02/13/2023
Section Cited
CCR
1596.841

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Current roster of children provided care in facility required.Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.This requirement is not met as by LPA observation, interview and observation

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Facility will submit via email to LPA Miranda a complete current roster of children no later than 02/13/2023, in additional for the years 2021 and 2023.
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Director was unable to produce copy a complete current roster of children. Also, Director was unable to produce copy of complete roster of the children for the year 2021 and 2022.
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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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6


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 WESTWOOD CHILD CARE CENTER
FACILITY NUMBER: 197417299
VISIT DATE: 02/10/2023
NARRATIVE
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person who signs the child in/out with full legal signature.

Facility was unable to produce a complete (LIC9040) copy of the children's roster during this inspection for the years 2021,2022 and 2023.

Facility understand that safe sleep log shall be document for all infants in care (age 0-24months).

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report
shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form (LIC9224) during this visit.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D).

An exit interview was conducted and a copy of this report, appeal rights and Notice of Site Visit was provided and reviewed with Jennie Lopez, Director.

SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC809 (FAS) - (06/04)
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