<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601954
Report Date: 08/24/2026
Date Signed: 08/24/2026 03:34:09 PM

Document Has Been Signed on 08/24/2026 03:34 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-INFANTSFACILITY NUMBER:
191601954
ADMINISTRATOR/
DIRECTOR:		MINOR, ALICIAFACILITY TYPE:
830
ADDRESS:101 S. BELLAGIO DR.TELEPHONE:
(310) 825-5086
CITY:LOS ANGELESSTATE: CAZIP CODE:
90095
CAPACITY: 60TOTAL ENROLLED CHILDREN: 47CENSUS: 37DATE:
08/24/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:19 PM
MET WITH:Arpine PanosyanTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/24/2026 at 03:19 p.m., Licensing Program Analyst (LPA) DeCondia Ferguson conducted an unannounced Case Management – Incident inspection at the above facility to follow up on an Unusual Incident Report (UIR) received by the Department regarding an incident involving Child #1 (C1).

Upon arrival, LPA met with Director Arpine Panosyan (RP), to whom the purpose of the inspection was announced. The Director guided LPA on a tour of the facility and conducted a census.

In the Lambs room, LPA observed 5 children with 3 staff; Ponies room 7 children with 5 staff; Bunny’s room 10 children with 4 staff; Penguin’s room 10 children with 4 staff; and Panda’s room 1 children with 5 staff.

The UIR reported that C1 was playing outdoors when C1 jumped from a wooden climbing block onto a cushioned mat and landed on C1's left leg. Following the incident, C1 cried and was unable to place weight on the left leg. Staff provided comfort and applied ice. C1's parent was notified and subsequently sought medical attention for C1. The facility later reported that C1 sustained a left tibia fracture and was placed in a cast and cast shoe.

During today's inspection, LPA interviewed Staff #1 (S1), who witnessed the incident, and RP regarding the circumstances surrounding the incident, supervision provided at the time of the incident, use of the wooden climbing block, actions taken following the incident, and notification of C1's parent.

C1 was not interviewed due to C1's age and developmental ability.

Raul Navarro
Decondia Ferguson
DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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)
Page: 2 of 3
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-INFANTS
FACILITY NUMBER: 191601954
VISIT DATE: 08/24/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA observed the climbing blocks to consist of six platforms of varying heights (two 4-inch, two 8-inch, and two 16-inch platforms) and two balancing beams, consistent with the product description provided by Community Playthings. Per the manufacturer's description, the recommended age range for the climbing blocks is 24 to 36 months. LPA observed the climbing blocks to be sturdy with no visible damage. LPA also observed the mat to be sturdy and attempted to move the mat using LPA's foot; the mat did not move.

During today’s inspection, LPA toured the facility and conducted interviews with Staff #1 (S1) and Reporting Party (RP). LPA obtained additional information regarding the circumstances surrounding the incident and the facility’s response. LPA also obtained the following documents: LIC 500 Staff Roster, LIC 9040 Child Care Facility Roster, product information/description for the wooden climbing block from Community Playthings, took photos of climbing blocks and mat utilized at time of incident, and C1's medical release.

At this time, additional information is required to complete the Department's investigation. LPA will conduct additional interviews. A subsequent visit will be conducted as necessary to complete the investigation.

No deficiencies are being cited during today's inspection.

An exit interview was conducted and the report was reviewed with Director Arpine Panosyan.

page 2

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

DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026
LIC809 (FAS) - (06/04)
Page: 3 of 3