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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197406923
Report Date: 05/07/2026
Date Signed: 05/07/2026 01:31:01 PM

Document Has Been Signed on 05/07/2026 01:31 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:KOGUMA YOUCHIEN, INC.FACILITY NUMBER:
197406923
ADMINISTRATOR/
DIRECTOR:		SAITO, YASUHIKOFACILITY TYPE:
850
ADDRESS:2351 255TH STREETTELEPHONE:
(310) 257-8880
CITY:LOMITASTATE: CAZIP CODE:
90717
CAPACITY: 40TOTAL ENROLLED CHILDREN: 38CENSUS: 33DATE:
05/07/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Tomomi Nagasako, DirectorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 5/7/2026 @ 9:00am, Licensing Program Analyst (LPA) Devon Carus conducted a Case Management Unusual Incident inspection to follow up on the self- reported incident that occurred on 04/15/2026 at Koguma Youchien Pre School located at 2351 255th St. Lomita, CA 90717. The El Segundo Regional Office received the incident report on 4/21/2026. Upon arrival, LPA observed 33 children being supervised by 6 staff members. All center staff that was present during today’s inspection had fingerprint clearance and are associated to the designated license number.

LPA interviewed the following: Director/ Staff member #1 (S1) and Staff Member #2 (S2) as the witnesses. The incident happened towards the middle of the day during nap time at approximately 1:00pm. S2 initially noticed the unidentified person in the restroom area of the pre-school when heading to the kitchen area. S2 initially asked this person if they were there for maintenance and they stated that they were. The unidentified individual proceeded to search the supply cabinet in the restroom area, and left an empty alcoholic drink container in the basket above the toilet in this restroom. Based on the information gathered through interviews, it revealed that the director/ S1 was immediately notified of this person, and the school went into a lock-down state during nap time.

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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Devon Carus
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2026
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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Document Has Been Signed on 05/07/2026 01:31 PM - It Cannot Be Edited


Created By: Devon Carus On 05/07/2026 at 12:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KOGUMA YOUCHIEN, INC.
FACILITY NUMBER: 197406923

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/18/2026
Section Cited
HSC
1531.15(b)

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1531.15 Secured perimeters; installation; conditions

(b) As used in this section, “secured perimeters” means fences that meet the requirements prescribed by this section.
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The director confirmed that since this incident occurred, the pre school will unlock the gate only after the trash pick up has arrived, monitor the gate/ entrance during the pick up, and to lock the gate immediately after the trash pick up is complete.
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This requirement was not met as evidenced by:

Based on LPAs interviews, all staff involved in the incident confirmed that the small gate used for trash pick up was unlocked during the time of the incident. The pre school center did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maureen Neal
NAME OF LICENSING PROGRAM MANAGER:
Devon Carus
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2026


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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: KOGUMA YOUCHIEN, INC.
FACILITY NUMBER: 197406923
VISIT DATE: 05/07/2026
NARRATIVE
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According to narratives provided by S1, and S2. The unidentified individual proceeded to leave the premises after being discovered. S1 and S2 searched the school grounds to find out if they had left anything more, or were still there and found nothing. Additionally, the Lomita Police were called on the day of the incident and instructed the director not to file a report since there was not any harm from the incident. Additionally, the children did not see the individual on the premises, and it was not certain how the individual entered the premises. Furthermore, information gathered from interviews indicates that the small gate to the outdoor yard of the preschool was unlocked during the time that the incident occurred.

LPA Carus inspected the outdoor play area involved in the incident, and observed it to be safe, though the gate that was unlocked during this incident was approximately 4 feet tall and is unlocked for a timeframe of 2 hours on Wednesdays for trash pick up. Though a child is unable to access this gate when it is closed, it is considered to be a potential hazard and poses/posed a potential health, safety or personal rights risk to persons in care due to it being unlocked during the time of the incident.

During today’s visit, the director confirmed that since this incident occurred, the pre school has implemented a system on trash pick up days to unlock the gate only after the trash pick up has arrived, monitor the gate during the pick up, and to lock the gate immediately after the trash pick up is complete. Additionally, the director agrees to look into ways to extend the small gate involved in this incident to a greater height.

At this time, based on the available information, 1 Type B-Violation will be cited.

The content of this report was read and discussed in detail with Tomomi Nagasako, preschool director.

An exit interview was conducted. The notice of site visit must be posted for 30 days upon receipt.

Appeal rights were reviewed and provided.

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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Devon Carus
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC809 (FAS) - (06/04)
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