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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494026
Report Date: 10/13/2023
Date Signed: 10/16/2023 10:36:23 AM


Document Has Been Signed on 10/16/2023 10:36 AM - 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: 9DATE:
10/13/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tomi Aoyama and James AoyamaTIME COMPLETED:
03:30 PM
NARRATIVE
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On 10/13/23, Licensing Program Analyst, V. Wheatley conducted an inspection and observed Tomi Aoyama, James Aoyama and one teacher Staff #1 supervising 9 infants. LPA observed 4 infants napping in 4 cribs and 5 infants on the floor inside of the classroom. LPA observed younger infants playing in the classroom and inquired about the only 4 cribs being utilized. LPA was informed by Tomi Aoyama and Staff #1 that the other children share the cribs. This is a Type B violation. See LIC 809D for deficiency.

Exit interview. Report provided.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023
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 10/16/2023 10:36 AM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: SHIRAYURI YOUCHIEN
FACILITY NUMBER: 197494026

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2023
Section Cited
CCR
101439.1(e)

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101439.1(e) Each infant's bedding shall be used for him/her only. Such bedding shall be replaced when wet or soiled, or when the crib, mat or cot is to be occupied by another infant.

(1) Bedding shall be changed daily, or more often if required by Subsection (e) above.
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Licensee / director will ensure that children are not using the same cribs for napping/sleeping. A plan of correction will be send to the Department by 10/16/2023 stating how they will make sure that the same children are not using the cribs. Either more cribs will be used or cots for older infants.
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This is evidenced by:

LPA observed 4 infants napping in 4 individual cribs. LPA observed younger infants awake in the classroom. LPA asked where do the younger infants sleep and was informed by Tomi A and Staff #1 they use the same cribs. This is potential risk to the health and safety of children in care.
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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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023
LIC809 (FAS) - (06/04)
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