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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414787
Report Date: 12/12/2023
Date Signed: 12/13/2023 08:51:45 AM

Document Has Been Signed on 12/13/2023 08:51 AM - 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:SHIRAYURI YOUCHIENFACILITY NUMBER:
197414787
ADMINISTRATOR:HIROKO KOZUCHIFACILITY TYPE:
850
ADDRESS:23325 SO. VERMONT AVENUETELEPHONE:
(310) 530-5830
CITY:TORRANCESTATE: CAZIP CODE:
90502
CAPACITY: 79TOTAL ENROLLED CHILDREN: 79CENSUS: 54DATE:
12/12/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Hiroko Kozuchi - DirectorTIME COMPLETED:
01:00 PM
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On 12/12/23, Licensing Program Analyst (LPA) Cristina Castellanos conducted an unannounced case management non-compliance inspection at the above-mentioned address. A follow up from the Non-compliance conference held on May 10, 2022 by El Segundo Child Care Regional Office. Upon arrival, LPA met with Director Hiroko Kozuchi. LPA explained the purpose of the visit and toured the facility’s inside and outside. Present during today’s inspection were 54 Children and 7 staff members.

During today’s inspection, LPA reviewed the following documents: LIS facility profile, Guardian Roster and LIC 500 Personnel Report dated 05/22/2022. Director Kozuchi was unable to provide LPA records of hours actually worked by staff members. Director Kozuchi informed LPA that Tomi Aoyama is responsible for maintaining time sheets but does not keep record of it.

LPA discussed the following with Director Kozuchi:

1. The importance of visual observation and supervision of children and having adequate staff at all times

2. Reporting all Unusual Incident and injuries to CCLD.

3. Maintaining a current LIC 500 Personnel Report

4. Maintaining record of hours actually worked by staff members.

An exit interview was conducted, and report reviewed with Director Hiroko Kozuchi. A copy of this report and


appeal rights were discussed and left with Director. A Notice of Site Visit was given and must remain posted
for 30 days.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2023
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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