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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414787
Report Date: 07/12/2023
Date Signed: 07/13/2023 12:51:46 PM


Document Has Been Signed on 07/13/2023 12:51 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:SHIRAYURI YOUCHIENFACILITY NUMBER:
197414787
ADMINISTRATOR:HIROKO KOZUCHIFACILITY TYPE:
850
ADDRESS:23325 SO. VERMONT AVENUETELEPHONE:
(310) 530-5830
CITY:TORRANCESTATE: CAZIP CODE:
90502
CAPACITY:79CENSUS: 57DATE:
07/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Hiroko KozuchiTIME COMPLETED:
05:45 PM
NARRATIVE
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On 7/12/2023 Licensing Program Analyst (LPA), V. Wheatley conducted an unannounced Annual Required Inspection for the preschool license. LPA met with the director Hiroko Kozuchi and toured the facility indoors and outdoors. LPA observed 57 children with 7 staff. Days and hours of operation are Monday through Friday 7:30am to 6:30pm.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions and other hazardous items are made inaccessible. All poisons are kept in a locked cabinet area. No poisons were observed during the inspection. When entering the premises, LPA inspected the classrooms on the left side (north) of the building. LPA observed a peach colored restroom which needs painting in the stalls. The rooms were cool and equipped with adequate temperature.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The staff removed two outdoor equipment during the inspection. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and hand washing facilities are in safe and sanitary operating condition. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. The facility is free of flies, insects and rodents. Facility has a functioning carbon monoxide and smoke detectors that meet statutory requirements.

LPA observed the staff in the two year old classroom changing diapers. LPA informed the staff to wash hands after each diaper change and recommended the diaper changing be done inside of the restroom.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHIRAYURI YOUCHIEN
FACILITY NUMBER: 197414787
VISIT DATE: 07/12/2023
NARRATIVE
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Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. Capacity and limitations as specified on the license are being maintained. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. The facility uses manual sign in and out sheets for parents to sign in/out children. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis, measles and current documentation of completed Mandated Reporter Training. Menus for breakfast, lunch and snacks are posted at least one week in advance where an authorized representative can view them.

Incidental Medical Services (IMS) are currently not being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, there are deficiencies are cited and Technical Advisories discussed with director.

An exit interview was conducted, a copy of this report was read and provided to the Licensee. This report shall me made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/13/2023 12:51 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: SHIRAYURI YOUCHIEN
FACILITY NUMBER: 197414787

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(f)(1)
Fixtures, Furniture, Equipment and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation during the inspection, the licensee did not comply with the section cited above in having a trash bin in the kitchen filled without a lid. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2023
Plan of Correction
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Licensee and director will ensure that all trash bins used for food, solid waste and diapers has a tight fitting lid. The director will submit a plan of correction to the Department by 7/17/23. A picture of a new trash bin is sufficent.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation and interview with the director, the licensee did not comply with the section cited above in that the director does not have current Mandated Reporter Training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/17/2023
Plan of Correction
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Licensee and director will ensure all staff have completed the Mandated Reporter Training. The training is required every two years. The director will submit a copy of her certificate of completion to the Department by 7/17/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
LIC809 (FAS) - (06/04)
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