197494026-8-17-2021-30-CC-MNEL-C6QR7T-20210910124650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197494026
Report Date: 08/17/2021
Date Signed: 08/17/2021 03:38:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/16/2021 and conducted by Evaluator Veronica Wheatley

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20210616142106

FACILITY NAME:	SHIRAYURI YOUCHIEN		FACILITY NUMBER:	197494026
ADMINISTRATOR:	AOYAMA,YOSHIO		FACILITY TYPE:	830
ADDRESS:	20706 NORMANDIE AVENUE		TELEPHONE:	(310) 530-5830
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90502
CAPACITY:	10	CENSUS: 5	DATE:	08/17/2021
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Tomi Aoyama and James Aoyama		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Facility operating out of ratio.

INVESTIGATION FINDINGS:

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On 8/17/2021 Licensing Program Analyst (LPAs) Veronica Wheatley and LIllian Castillas conducted an unannounced in person inspection regarding the above allegations at 10:00am. LPAs met with the Tomi Aoyama and son James Aoyama. LPA toured the entire premises and observed Staff #1 and Staff #2 supervising 5 infants upon arrival.

LPA Wheatley interviewed staff and witnesses regarding the staff operating out of ratio. Mr. & Mrs. Aoyama deny allegations of operating out of ratio.

LPAs did not observe the facility operating out of ratio however based on interviews with witnesses and information which was obtained during the investigation the allegation is substantiated for operating out of ratio. The preponderance of evidence has been met.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 5

Control Number 30-CC-20210616142106

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SHIRAYURI YOUCHIEN	FACILITY NUMBER: 197494026
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/18/2021 Section Cited CCR 101416.5(b)	1 2 3 4 5 6 7	101416.5(b) Staff-Infant Ratio-There shall be a ratio of one teacher for every four infants in attendance.	1 2 3 4 5 6 7	Licensee agrees to make sure the facility operates within the ratios of Title 22 Reguations..Licensee will have a meeting with staff regarding ratios and will submit a written document with names of staff that attended the meeting and that they understand. Licenseee will submit a plan of correction by August 18, 2021
	8 9 10 11 12 13 14	LPA Wheatley interviewed witnesses who stated the licensee failed to make sure that the facility was operating within required ratios for infants. The witnesses observed more than 5 children with one teacher and another occassion observed over 8 children with two teachers.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/16/2021 and conducted by Evaluator Veronica Wheatley

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20210616142106

FACILITY NAME:	SHIRAYURI YOUCHIEN		FACILITY NUMBER:	197494026
ADMINISTRATOR:	AOYAMA,YOSHIO		FACILITY TYPE:	830
ADDRESS:	20706 NORMANDIE AVENUE		TELEPHONE:	(310) 530-5830
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90502
CAPACITY:	10	CENSUS: 5	DATE:	08/17/2021
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Tomi Aoyama and James Aoyama		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Infant sustained injury while in care.

INVESTIGATION FINDINGS:

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On 8/17/2021 Licensing Program Analyst (LPAs) Veronica Wheatley and LIllian Casillas conducted an unannounced in person inspection regarding the above allegations at 10:00am. LPAs met with the Tomi Aoyama and son James Aoyama. LPA toured the entire premises and observed Staff #1 and Staff #2 supervising 5 infants upon arrival.

On 6/25/2021, LPA Wheatley interviewed Ms. Aoyama and James Aoyama who stated they were unaware of any children injured on the premises. LPA asked the protocol and was informed that if a child is injured first aid is administered immediately and depending on the injury the parents are contacted. Today, LPA showed them a photo of Child #1. Ms. Aoyama stated she didn't recall the child being injured. Mr. Aoyama stated the child may have scratched himself on the face.

Based on the investigation, which included interviews with relevant parties, observation, and record review the allegation is unsubstantiated. Unsubstantiated means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.
Exit interview was conducted and a copy of the report was provided to Yoshio, Tomi and James Aoyama.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 30-CC-20210616142106

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SHIRAYURI YOUCHIEN	FACILITY NUMBER: 197494026
	VISIT DATE: 08/17/2021

NARRATIVE

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Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report
documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive
days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. 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 of Receipt (LIC 9224 form must be
maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the
Acknowledgement of Receipt of Licensing Reports (LIC 9224).

Exit interview was conducted and a copy of the report was provided to Yoshio, Tomi and James Aoyama.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 5