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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601484
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:57:14 PM

Document Has Been Signed on 02/27/2024 02:57 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 EDUCATIONFACILITY NUMBER:
191601484
ADMINISTRATOR:AMY AGNEWFACILITY TYPE:
850
ADDRESS:101 S. BELLAGIO DR.TELEPHONE:
(310) 825-5086
CITY:LOS ANGELESSTATE: CAZIP CODE:
90095
CAPACITY: 122TOTAL ENROLLED CHILDREN: 122CENSUS: 78DATE:
02/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Alicia Minor, Center Director TIME COMPLETED:
03:05 PM
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On February 27, 2024 at 1:46PM, an unannounced Case Management visit was conducted by Regional Manager (RM) Victor Bautista, Rita Ramos, Licensing Program Manager I, and Licensing Program Analyst (LPA) Lilia Hernandez for the purpose of serving an Immediate Exclusion for Christopher Roriguez, and employe of this facility. RM and LPA met with Alicia Minor at the facility, located in Los Angeles Ca 90095.
Licensee representatives Alicia Minor were served with the following by Regional Manager Victor Bautista:
· ORDER TO INDIVIDUAL OF IMMEDIATE EXCLUSION FROM ALL FACILITIES: Christopher Rodriguez
· Order to Licensee/Facility of Immediate Exclusion from Facility: Christopher Rodriguez
· Appeal Rights
· Government Code 11522

RM, LPM and LPA advised Facility Representative that Christopher Rodriguez is excluded from UCLA EARLY CARE AND EDUCATION 191601484, and any other licensed facilities by the Department of Social Services. Licensee and Christopher Rodriguez have 15 days to submit an appeal. The address for the appeal was provided to Licensee. Licensing staff served the exclusion letter to Christopher Rodriguez via Certified mail on 02/27/2024.
Licensee representative Notified RM and LPA that Christopher Rodriguez was placed on administrative leave 12/18/2023 and has not been present at this facility since that date.

Exit interview was conducted with Alicia Minor, Director. The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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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