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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600834
Report Date: 09/14/2026
Date Signed: 09/14/2026 02:58:47 PM

Document Has Been Signed on 09/14/2026 02:58 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 INTERV PROG DEV HANDICAPPED INF & CHILDFACILITY NUMBER:
191600834
ADMINISTRATOR/
DIRECTOR:		DANE FITZMORRISFACILITY TYPE:
830
ADDRESS:1000 VETERAN AVE 23-31, 24-17TELEPHONE:
(310) 825-4821
CITY:LOS ANGELESSTATE: CAZIP CODE:
90095
CAPACITY: 26TOTAL ENROLLED CHILDREN: 15CENSUS: 7DATE:
09/14/2026
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:29 AM
MET WITH:Dane FitzmorrisTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On 09/14/2026, Licensing Program Analyst (LPA) DeCondia Ferguson conducted an unannounced Required 3-Year inspection at UCLA Intervention Program for Developmentally Handicapped Infant & Children Center. LPA arrived at the facility at 08:29 a.m. and met with Director Dane Fitzmorris. LPA explained the purpose of the inspection and provided Director with a copy of the LIC 125, Entrance Checklist – Child Care Centers, to facilitate the inspection. Director Fitzmorris provided information regarding program operations and guided LPA on a tour of the facility. LPA conducted a review of the facility's compliance with applicable Title 22 regulations and health and safety requirements.

Facility Information and Census

UCLA Intervention Program for Developmentally Handicapped Infant & Children Center is located at 1000 Veteran Avenue, Los Angeles, CA 90095. The program is located on the second floor and occupies the majority of the North Wing.

The facility has a licensed capacity of 26 children. Per Director, toddler program hours are Monday through Friday from 09:00 a.m. to 12:00 p.m., with toddlers attending on an alternating schedule. Infants attend on Tuesdays from 01:30 p.m. to 03:30 p.m.

The facility operates as a specialized Intervention Program for Developmentally Handicapped Infants and Children. Per Director, parents remain on the premises while their children receive care and participate in program services. For the toddler program parents are in attendance for 1 hour out of the 3 hours of care.

Raul Navarro
Decondia Ferguson
DATE: 09/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 INTERV PROG DEV HANDICAPPED INF & CHILD
FACILITY NUMBER: 191600834
VISIT DATE: 09/14/2026
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LPA observed seven children and five teaching staff, one Occupational Therapist, and the Director present during the inspection. LPA reviewed the LIC 9040, Children's Roster, which reflected 15 children currently enrolled. LPA observed children to be under the care and supervision of teaching staff during the inspection. The observed census was within the capacity and limitations specified on the facility license.

LPA observed required licensing documents posted in a prominent and publicly accessible area. LPA conducted a walkthrough of the indoor and outdoor areas and inspected the areas identified on the facility sketch.

Classrooms and Physical Plant

LPA observed three licensed classrooms on the premises, consisting of two Toddler Rooms and one Infant Room. Each Toddler Room has an attached Movement Room. LPA also observed one Therapy Room on the premises.

LPA observed the classrooms, Movement Rooms, Therapy Room, floors, restrooms, and toileting areas to be clean, organized, safe, and maintained in sanitary condition. Classrooms were furnished with age-appropriate furniture, toys, equipment, and materials that were observed to be in good repair and free of visible hazards. Children's personal belongings were stored in designated cubbies within each classroom.

Trash cans in the classrooms and restrooms were equipped with tight-fitting lids. Cleaning compounds, disinfectants, medications, and other hazardous materials were securely stored and made inaccessible to children in care. Materials, toys, and equipment accessible to children were observed to be safe and non-toxic. Floors were observed to be clean and free of visible hazards. No poisons were observed in the classrooms or restrooms.

Per Director, children do not nap while in care. LPA did not observe napping or sleeping equipment at the facility.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2026
LIC809 (FAS) - (06/04)
Page: 3 of 10
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 INTERV PROG DEV HANDICAPPED INF & CHILD
FACILITY NUMBER: 191600834
VISIT DATE: 09/14/2026
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Restrooms and Diapering Areas

LPA observed operational toilets and sinks available for children in care. Room 1 was equipped with two sinks and two toilets; Room 2 was equipped with one sink and one toilet; and the infant restroom was equipped with one sink and one toilet. LPA observed changing tables located adjacent to sinks in the restroom areas.

Children's toilets and sinks were observed to be age-appropriate in height and size and readily accessible to children in care. Restrooms were adequately stocked with toilet paper and paper towels and had adequate lighting and ventilation. Sink and toileting surfaces were observed to be constructed of cleanable, moisture-resistant materials and maintained in sanitary condition. A separate staff restroom was available and inaccessible to children in care.

Kitchen, Food Service, and Drinking Water

LPA observed the kitchen, food preparation, and food storage areas to be clean and maintained in sanitary condition. The refrigerator was observed to be operational. Cleaning agents, detergents, and other hazardous substances were securely stored and separated from food supplies. Solid waste containers were observed to be in good repair and equipped with tight-fitting covers. LPA observed the kitchen to be inaccessible to children in care.

Per Director, children bring their own lunches to the facility, and the facility does not provide food to children in care.

LPA observed drinking water to be readily available to children both indoors and outdoors. Drinking water is provided using paper cups and water pitchers. Per Director, water pitchers are filled using a Brita filtered water system and provided to each classroom.

Health and Safety

Telephone service, heating, lighting, and ventilation were evaluated and observed to be adequate. LPA observed no swimming pools or other bodies of water on the premises. Per Director, firearms and ammunition are not permitted or stored on the premises.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2026
LIC809 (FAS) - (06/04)
Page: 4 of 10
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 INTERV PROG DEV HANDICAPPED INF & CHILD
FACILITY NUMBER: 191600834
VISIT DATE: 09/14/2026
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Per Director, Incidental Medical Services (IMS) are available when needed. Due to the specialized nature of the intervention program, parents remain on the premises while their children are receiving care and services and are responsible for administering medication to their child when present. In the event IMS are required when a parent is not available on the premises, facility staff may provide the necessary services in accordance with the facility's approved procedures. LPA reviewed the facility's IMS Plan of Operation during today's inspection. LPA also inspected the designated medication storage area and observed that no medications were currently being stored for children in care. Per Director, there are currently no enrolled children who require refrigerated medication.

LPA observed tamper-resistant electrical outlets throughout the facility. LPA observed smoke detectors and carbon monoxide detectors throughout the facility. Per Director, the smoke and carbon monoxide detection systems are connected directly to the fire department and are not tested by facility staff or LPA during the inspection. Director reported that testing of the systems is conducted by the fire department.

LPA observed fire extinguishers and first aid kits available in each of the three classrooms. LPA reviewed the fire extinguisher service tags, which reflected a service date of 08/12/2026. First aid kits were inspected and observed to be adequately stocked with necessary first aid supplies.

LPA reviewed the facility's emergency disaster drill log. The most recent drill was documented as having been conducted on 06/16/2026.

Outdoor Activity Space

The facility has one fully enclosed and fenced outdoor activity area. LPA inspected the outdoor play area and observed the play equipment to be maintained in safe condition and free of visible hazards. Required cushioning material was observed beneath and around climbing structures to provide fall protection. The outdoor activity area was observed to be free of debris and provided adequate shade for children in care.

Per Director, facility staff clean the outdoor play area, and UCLA Buildings and Grounds staff service the yard on Thursday mornings. LPA reminded Director that children shall remain under the supervision of qualified staff while in care, including during outdoor activities.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2026
LIC809 (FAS) - (06/04)
Page: 5 of 10
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 INTERV PROG DEV HANDICAPPED INF & CHILD
FACILITY NUMBER: 191600834
VISIT DATE: 09/14/2026
NARRATIVE
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Sign-In/Sign-Out

The facility utilizes a paper sign-in/sign-out system. LPA reviewed the sign-in/sign-out documentation and observed the children present during the inspection to be properly documented.

Children's Records

LPA reviewed a sample of children's records for required documentation, including, as applicable, Admission Agreements; LIC 613A, Personal Rights; LIC 700, Identification and Emergency Information; LIC 701, Physician's Report; LIC 702, Child's Preadmission Health History – Parent's Report; LIC 995, Notification of Parents' Rights; LIC 627, Consent for Emergency Medical Treatment; and immunization records. Children's records reviewed were observed to contain the required documentation.

No infants were present during today's inspection. However, LPA reviewed one currently enrolled infant's record to verify compliance with applicable recordkeeping requirements. The infant's record was reviewed for an Admission Agreement; LIC 613A, Personal Rights; LIC 700, Identification and Emergency Information; LIC 701, Physician's Report; LIC 702, Child's Preadmission Health History – Parent's Report; LIC 995, Notification of Parents' Rights; LIC 627, Consent for Emergency Medical Treatment; and immunization records. The infant's record reviewed was observed to contain the required documentation. There is no sleep log as children do not nap. Per Director LIC9227 is not completed as parents are on site.

Staff Records

LPA reviewed a sample of staff records for required documentation, including educational qualifications; immunization records for measles and pertussis and documentation regarding influenza vaccination/declination, as applicable; tuberculosis clearance or risk assessment; LIC 501, Personnel Record; LIC 503, Health Screening Report; LIC 508, Criminal Record Statement; LIC 9108, Statement Acknowledging Requirement to Report Child Abuse; current Mandated Reporter Training certificates; current CPR/First Aid, and LIC 9052, Employee Rights.

LPA verified that at least one staff member with current Pediatric CPR and First Aid certification was present during the inspection. LPA also verified documentation of required Preventive Health and Safety training, including nutrition and lead poisoning prevention training, as applicable. Staff records reviewed reflected required criminal record clearances/associations. Page 5

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2026
LIC809 (FAS) - (06/04)
Page: 6 of 10
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 INTERV PROG DEV HANDICAPPED INF & CHILD
FACILITY NUMBER: 191600834
VISIT DATE: 09/14/2026
NARRATIVE
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Director Dane Fitzmorris was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. LPA discussed the Community Care Licensing website www.ccld.ca.gov which provides access to resources such as forms, regulations, Provider Information Notices (PINS), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 101212).

Director Dane Fitzmorris was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco on the premises. Director Dane Fitzmorris states there is no smoking in the facility.



The following were also discussed with the Director Dane Fitzmorris:

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:


Community Care Licensing
300 Continental Blvd., #290A
El Segundo, CA 90245


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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2026
LIC809 (FAS) - (06/04)
Page: 7 of 10
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 INTERV PROG DEV HANDICAPPED INF & CHILD
FACILITY NUMBER: 191600834
VISIT DATE: 09/14/2026
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Assembly Bill 1207: California Child Care Workers; Mandated Training Requirement. Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete Mandated Reported Training prior to March 30, 2018 and renew training every two years at: www.mandatedreporterca.com.

Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program or an accredited college or university.

Criminal Record Clearance: Director Dane Fitzmorris was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.



Lead Testing: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead
contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code section 1597.16.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP.).

LPA verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP. Child Care Center completed testing January 12, 2023 and no Lead Exceedances.
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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2026
LIC809 (FAS) - (06/04)
Page: 8 of 10
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 INTERV PROG DEV HANDICAPPED INF & CHILD
FACILITY NUMBER: 191600834
VISIT DATE: 09/14/2026
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LPA referred Director Dane Fitzmorris to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information)

Safe Sleep: LPA discussed the safe sleep regulations with Director Dane Fitzmorris and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director Dane Fitzmorris of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS): This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org: Director Dane Fitzmorris was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2026
LIC809 (FAS) - (06/04)
Page: 9 of 10
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 INTERV PROG DEV HANDICAPPED INF & CHILD
FACILITY NUMBER: 191600834
VISIT DATE: 09/14/2026
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Based on observations made, records reviewed, and information obtained during today's inspection, the facility was observed to be operating in compliance with applicable Title 22 regulations, therefore, no deficiencies were cited during today’s inspection.

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

Exit interview conducted and report was reviewed with the Director Dane Fitzmorris

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2026
LIC809 (FAS) - (06/04)
Page: 10 of 10