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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601954
Report Date: 08/25/2026
Date Signed: 08/25/2026 03:18:07 PM

Document Has Been Signed on 08/25/2026 03:18 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: 42DATE:
08/25/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:52 PM
MET WITH:aRPINETIME 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 08/25/2026 at 02:52 p.m., Licensing Program Analyst (LPA) DeCondia Ferguson conducted an unannounced Case Management – Incident inspection at the above facility for the purpose of concluding an investigation regarding an Unusual Incident Report (UIR) received by the Department involving Child #1 (C1). Upon arrival, LPA met with Director Arpine Panosyan, to whom the purpose of the inspection was explained.

The UIR reported that C1 sustained an injury after jumping from a wooden climbing block onto a cushioned mat and landing on C1's left leg. C1 was subsequently diagnosed with a left tibia fracture and received a cast and cast shoe.

During the course of the investigation, LPA interviewed Staff #1 (S1), RP, and Parent #1 (P1). C1 was not interviewed due to C1's age and developmental ability. LPA also reviewed and/or obtained the LIC 9040 Child Care Facility Roster, product information for the climbing blocks from Community Playthings, and C1's medical release.

Interviews revealed that S1 was approximately three feet from C1 and supervising the activity when the incident occurred. S1 reported having an unobstructed view of C1 and observed C1 independently climb onto the equipment and successfully jump onto the mat once. During C1's second jump, S1 observed C1 land with the majority of C1's weight on the left leg. S1 reported C1 did not fall, twist the leg, become caught in the equipment, or strike C1's head. C1 remained in a squatting position, groaned, and subsequently would not bear weight on the left leg. S1 immediately responded, comforted C1, applied ice, and notified Director. P1 was subsequently contacted.

Raul Navarro
Decondia Ferguson
DATE: 08/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2026
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 4
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 4
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: 08/25/2026
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
P1 reported arriving at the facility and observing C1 sitting calmly with S1 but unwilling to bear weight on the left leg. P1 immediately sought medical evaluation for C1. Initial X-rays did not identify a fracture; however, the medical provider suspected an occult fracture. C1 was evaluated by pediatric orthopedics the following day, at which time additional X-rays confirmed a fracture. P1 reported the medical provider described the injury as a "toddler fracture" and stated that the injury was consistent with the reported mechanism of C1's landing. C1 was placed in a cast and cast shoe and provided activity restrictions.

During the investigation, 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. LPA also measured the distance from the top of the climbing blocks to the ground and found the distance to be consistent with the height description. Per the manufacturer's product information provided to LPA, the recommended age range for the climbing blocks is 24 to 36 months. C1 was 22 months old at the time of the incident. 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. Interviews did not identify any previous injuries or concerns involving the climbing blocks.

RP reported the climbing equipment was inspected following the incident and no defects or instability were identified. As a precautionary measure, RP removed the climbing blocks from the area following the incident. P1 confirmed the climbing blocks have been removed and reported no prior concerns regarding the equipment, C1's supervision, or staff's response to the incident.

The investigation identified a discrepancy regarding the date of the incident. The UIR identified the incident date as 08/06/2026. During interview, P1 reported the incident occurred on 08/05/2026 at approximately 4:00 p.m., C1 was initially evaluated at urgent care on 08/05/2026, and the fracture was confirmed following an orthopedic evaluation on 08/06/2026.

Based on interviews conducted, documentation reviewed, and observations made by LPA, the information obtained indicates that C1's injury occurred while C1 was engaged in a supervised climbing/jumping activity. S1 was in close proximity to C1 and observed the incident. No evidence was obtained indicating a lack of supervision or that a defect or instability of the equipment or mat contributed to the injury. Although the manufacturer's information identified a recommended age range beginning at 24 months and C1 was 22

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

DATE: 08/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 08/25/2026
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
months old at the time of the incident, the investigation did not establish that the age difference contributed to C1's injury. The injury appears to have resulted from the manner in which C1 landed during the activity.

Based on the information obtained during the investigation, no violation of Title 22 regulations was established and the incident investigation is concluded.

No deficiencies are being cited as a result of today's inspection. The incident investigation is concluded.

A notice of site visit was given. Appeal rights provided.

Exit interview conducted and report was reviewed with the Director Arpine Panosyan. A copy of this report was provided and must be posted for 30 days.

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

DATE: 08/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026
LIC809 (FAS) - (06/04)
Page: 4 of 4