191601484-4-6-2023-58-CC-AALA-CQMVDY-20230406162132

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191601484
Report Date: 04/06/2023
Date Signed: 04/06/2023 04:21:38 PM

Document Has Been Signed on 04/06/2023 04:21 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 EARLY CARE AND EDUCATION		FACILITY NUMBER:	191601484
ADMINISTRATOR:	AMY AGNEW		FACILITY TYPE:	850
ADDRESS:	101 S. BELLAGIO DR.		TELEPHONE:	(310) 825-5086
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90095
CAPACITY: 122	TOTAL ENROLLED CHILDREN: 140	CENSUS: 77	DATE:	04/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:31 AM
MET WITH:	Amy Agnew, Director		TIME COMPLETED:	04:30 PM

NARRATIVE

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On 04/06/2023 at 9:02 AM, Lilia Hernandez and Antonio Almanza, Licensing Program Analysts (LPAs) conducted an unannounced Annual Required Visit. LPAs met with Amy Agnew, Director and explained the purpose of the visit. Director guided LPAs on a tour of the facility. Days and hours of operation are Monday through Friday from 7:30 AM to 5:30 PM. LPA verified facility phone number is 310-825-5086. During today’s visit there are 14 adults providing care to 77 preschool children.

The facility is composed of 5 preschool classrooms. The Owls and Ducks classroom is located on the south end of the facility and share a bathroom and kitchenette. The Panda classroom is located next to the office and has its own bathroom and kitchenette. The playground for this classrooms is located in front of the classrooms. The Koalas and Eagles classrooms are located on the north end of the facility have their own kitchenettes and share a bathroom. This classroom have a playground in front and behind the classrooms. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. All toilets and hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe.

Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. The facility is free of flies, insects and rodents. Facility has functioning smoke detectors and carbon monoxide detectors in each classroom that meet statutory requirements. LPAs observed fire extinguishers in each classroom that were serviced on 09/06/22. Page 1.

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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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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 EARLY CARE AND EDUCATION	FACILITY NUMBER: 191601484
	VISIT DATE: 04/06/2023

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Director was advised that prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. No individuals excluded by the Department are allowed to be present.

Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The name of the child care center director or fully qualified teacher(s) designated to act in the director’s absence has been reported to the Department.

Director was advised that all children are under supervision, including visual supervision, of a teacher at all times. Facility shall maintain a ratio of one teacher supervising no more than 12 children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child. LPA reviewed a sample of staff files and observed files were complete with documentation of meeting qualification requirements, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Menus are posted at least one week in advance where an authorized representative can view them.

Incidental Medical Services (IMS) are currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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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 EARLY CARE AND EDUCATION	FACILITY NUMBER: 191601484
	VISIT DATE: 04/06/2023

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Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

During today’s visit the facility is in substantial compliance. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Amy Agnew.

Page 3.

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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