191690248-5-22-2026-58-CC-DFEN-DUBRE4-20260522125655

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191690248
Report Date: 05/22/2026
Date Signed: 05/22/2026 12:57:54 PM

Document Has Been Signed on 05/22/2026 12:57 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:	BEVERLY GLEN PLAYGROUP, INC.		FACILITY NUMBER:	191690248
ADMINISTRATOR/ DIRECTOR:	SHADI BAKHTIARI		FACILITY TYPE:	850
ADDRESS:	10409 SCENARIO LN.		TELEPHONE:	(310) 470-0992
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90077
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 17	CENSUS: 12	DATE:	05/22/2026
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:32 AM
MET WITH:	SHADI BAKHTIARI		TIME VISIT/ INSPECTION COMPLETED:	01:30 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 05/22/2026 at 08:32 am, Licensing Program Analyst (LPA) DeCondia Ferguson conducted an Unannounced Required 3-Year inspection at the above facility. Upon arrival, LPA observed staff conducting child sign-in procedures at the entrance gate to the facility. LPA met with Center Director, Shadi Bakhtiari and discussed the purpose of the visit. The Director guided LPA on a tour of the facility inside and out. This facility operates Monday through Friday; the morning program is from 9:00a.m. to 12:30p.m. with an option to stay until 2:00p.m. Program services children 2 to 5 years of age. LPA observed 12 children present with 1 Center Director and 4 teachers and 1 parent volunteer. LPA verified that all adults present in the facility have obtained criminal record clearances and are associated to the facility. LPA also reviewed the sign in and sign out sheet to verify the census. The program uses the Playground App Electronic Sign-In/Out system. Children were properly documented during the inspection. LPA observed all required postings in a prominent area. A walk through of the classroom space was conducted. Classrooms were observed to be clean, well-organized, and free of potential hazards. Furniture was in good repair and equipped with age-appropriate furniture, toys, and materials. Trash cans in all classrooms had tight-fitting lids, and all cleaning supplies, disinfectants, and other hazardous materials were stored securely in locked cabinets, inaccessible to children. All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic-free. Page 1

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

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: BEVERLY GLEN PLAYGROUP, INC.	FACILITY NUMBER: 191690248
	VISIT DATE: 05/22/2026

NARRATIVE

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Telephone service, heating, lighting and ventilation were evaluated and found to be adequate. Per Director there is no smoking on the premises. No pools or bodies of water were observed on the premises.

Children’s belongings are stored outside of the classrooms on hooks. Per Director children do not take naps, but if they require a place to rest an area is provided inside the classroom. Per Director in the event children become ill the designated isolation area is located in the Director’s office. Adequate provisions were observed for the isolation and supervision of sick children.

LPA observed tamper-resistant electrical outlets installed throughout the facility. The facility is equipped with operational smoke and carbon monoxide detectors, tested during the inspection, in compliance with Title 22, Section 101238(b). Fire extinguishers (2A:10BC) were observed throughout the facility with a current service date of July 2, 2025, in accordance with Title 22, Section 101238(b)(1). The First Aid kit was complete in accordance with Title 22, Section 101226.

Per Director Incidental Medical Services are not provided. The facility does not administer nonprescription medications.

The fire drill log was reviewed and found to be current in accordance with Title 22, Section 101237. Last drill was conducted 03/18/2026. Per Director drills are conducted every other month.

The facility maintains operational flush toilets for children and staff in accordance with licensing requirements. During the inspection, bathroom and toileting areas were evaluated. Sinks are constructed of cleanable materials and maintained in a sanitary condition, with surfaces resistant to moisture and slipping hazards. LPA observed that the number of toilets (2) and sinks (3) is sufficient to meet the center’s licensed capacity. Toilets and sinks are age-appropriate in height and size to accommodate children in care and are readily accessible to children in care. Restrooms were adequately stocked with toilet paper and paper towels, and tight-fitting trash can lid. Bathroom areas were observed to be clean, with adequate lighting and ventilation. A separate staff restroom is available and inaccessible to children in care.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

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: BEVERLY GLEN PLAYGROUP, INC.	FACILITY NUMBER: 191690248
	VISIT DATE: 05/22/2026

NARRATIVE

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Cleaning compounds, medications, and other hazardous items were observed to be inaccessible to children in accordance with Title 22, Section 101238(a). No poisons were observed in the classrooms or bathrooms.
Based on observations made during the inspection, the facility is in compliance and meets Title 22 requirements for toilet and handwashing facilities.

Kitchen, food preparation, and food storage areas were observed to be clean, sanitary, and well maintained in accordance with Title 22, Section 101227 (Food Service). Per the Director, the program does not provide meals. Children bring snacks and lunches from home with ice packs included to maintain appropriate food temperatures. If a child’s lunch requires refrigeration, the program stores the item in the refrigerator. Food and snacks were reviewed for availability, quantity, and appropriateness for children in care.

The refrigerator was observed to maintain safe temperatures. Cleaning agents, detergents, and other hazardous substances were securely stored separately from food supplies in cabinets equipped with safety latches. Solid waste containers were observed to have tight-fitting covers and to be maintained in good repair.

Drinking water was observed to be readily available indoors and outdoors. Per Director children bring in bottled containers and are refilled by a filtered water system through reverse osmosis system through Culligan. Culligan services once every six months.

The outdoor play area was inspected, all fully enclosed and fenced. Outdoor play equipment was observed to be maintained in a safe condition and free of hazards. The outdoor activity surface was observed to be safe and free of debris. Per Director, the yard is cleaned daily by staff. Per Director a cleaning crew comes in daily (except weekends) at the end of the day. LPA observed a large sandbox located in the outdoor play area. Per Director, the sandbox is raked daily and routinely inspected for debris, foreign objects, and animal feces, including cat feces, to ensure the area remains clean, sanitary, and safe for children in care. At the time of the inspection, the sandbox appeared clean and free of observable hazards. Required cushioning material was present beneath and around climbing structures to absorb falls in accordance with Title 22, California Code of Regulations, Section 101238 (Buildings and Grounds). There is adequate shade in the play yard. LPA advised that no children shall be left without the supervision of a teacher at any time.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

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: BEVERLY GLEN PLAYGROUP, INC.	FACILITY NUMBER: 191690248
	VISIT DATE: 05/22/2026

NARRATIVE

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Children’s records were reviewed for Admission Agreement, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 613-Personal Rights, LIC 702-Health History, and LIC 701 Physicians Report, and Immunization Records and were found to be complete.

Staff records were reviewed for Education, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, LIC503- Health Screening, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. All required immunizations were documented. All Mandated Certifications were up to date. There is at least one person trained in CPR and Pediatric First Aid and at least one person with one hour of training in the importance of childhood nutrition during this inspection. All staff present had current criminal record clearances on file.

Director 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 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 states there is no smoking in the facility.

The following were also discussed with the Director:

Assembly Bill 633: Upon receipt of a citation for a Type A Deficiency, the director shall post the licensing report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report (LIC 809D/9099D) to parents/guardians of children in care at the facility by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.
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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

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: BEVERLY GLEN PLAYGROUP, INC.	FACILITY NUMBER: 191690248
	VISIT DATE: 05/22/2026

NARRATIVE

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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. 209A El Segundo, Ca 90245

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 Shadi Bakhtiari 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.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

LIC809 (FAS) - (06/04)

Page: 6 of 8

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: BEVERLY GLEN PLAYGROUP, INC.	FACILITY NUMBER: 191690248
	VISIT DATE: 05/22/2026

NARRATIVE

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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 September 28, 2022, in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP and there is no lead exceedance.

LPA referred licensee [or facility representative] 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 Shadi Bakhtiari 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 Shadi Bakhtiari 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) - Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

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: BEVERLY GLEN PLAYGROUP, INC.	FACILITY NUMBER: 191690248
	VISIT DATE: 05/22/2026

NARRATIVE

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MyChildCarePlan.org – Director Shadi Bakhtiari 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.

LPA reminded Director that Mandated Reporter and CPR/First Aide must be completed every two years.

A notice of site visit was given and must remain posted for 30 days. This report shall be made available to the public upon request.

Exit interview conducted and report was reviewed with Director Shadi Bakhtiari

Appeal Rights provided.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

LIC809 (FAS) - (06/04)

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