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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494026
Report Date: 04/22/2022
Date Signed: 04/25/2022 01:32:12 PM


Document Has Been Signed on 04/25/2022 01:32 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:SHIRAYURI YOUCHIENFACILITY NUMBER:
197494026
ADMINISTRATOR:AOYAMA,YOSHIOFACILITY TYPE:
830
ADDRESS:20706 NORMANDIE AVENUETELEPHONE:
(310) 530-5830
CITY:TORRANCESTATE: CAZIP CODE:
90502
CAPACITY:10CENSUS: 6DATE:
04/22/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Yoshio Aoyama & Tomi AoyamaTIME COMPLETED:
02:00 PM
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On 4/22/2022, Licensing Program Analysts (LPAs), Veronica Wheatley and Lillian Casillas conducted an unannounced Plan of Correction inspection and met with the Licensee, Yoshio Aoyama, and Tomi Aoyama (teacher and licensee's spouse). LPA Casillas contacted Language Link to interpret on LPAs' behalf in Japanese. Tomi Aoyama primarily communicated with the LPAs, despite the Licensee's presence during the inspection. The Licensee's son, James Aoyama, was present in the infant room during the inspection.

LPAs toured the infant program and observed 6 infants supervised by three adults upon arrival. LPAs observed the staff supervising within proper capacity and ratios. LPAs reviewed completed LIC 9227 Individual Infant Sleeping Plan forms for all infants up to 12 months of age.

LPAs did not observe any children in strollers. LPAs did not observe any strollers inside of the classroom. However, two strollers were observed to be stored in a large children's restroom.

The Language Link interpreter asked the Licensee if the Type A violation report was provided to the parents. The Licensee provided copies of the signed LIC 9224. The interpreter also explained the importance of submitting LIC 624 (Unusual Incident Reports) in a timely manner. In addition, the interpreter explained the difference between utilizing incident reports and ouch reports. LPAs observed a sample of an ouch report.

No deficiencies are being cited during today's visit. LPA Wheatley issued two LIC 9102 Advisory Notes - Technical Assistance regarding napping mats and diaper changing procedures.

An exit interview was conducted with licensee with the Japanese interpreter. LPAs provided a copy of this report to Licensee, Yoshio Aoyama, as well as a Notice of Site Visit.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022
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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