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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414787
Report Date: 04/18/2022
Date Signed: 04/18/2022 04:58:13 PM

Document Has Been Signed on 04/18/2022 04:58 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:YOSHIMI, MORIFACILITY TYPE:
850
ADDRESS:23325 SO. VERMONT AVENUETELEPHONE:
(310) 530-5830
CITY:TORRANCESTATE: CAZIP CODE:
90502
CAPACITY: 79TOTAL ENROLLED CHILDREN: 79CENSUS: 38DATE:
04/18/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:A. Aoyama & Hiroko KozuchiTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Veronica Wheatley and Lillian Casillas conducted an unannounced inspection and met with the licensee Yoshio Aoyama. LPA Casillas contacted language link to interpret on LPA's behalf. Licensee informed LPAs the new director Hiroko Kozuchi was on the way to the facility. LPAs met with Hiroko Kozuchi who stated she became the director a year ago.

LPAs observed 38 children on the premises. During the inspection, LPAs observed a preschool aged Child #1 inside of the restroom alone. The teacher was inside the 4 and 5 year old classroom with the other students. LPAs asked the director to come observed the child inside of the restroom alone. At approximately 4:15pm, LPAs observed three (3) children coming from outdoor play ground and going to the restroom inside the building alone without supervision. The director was informed. A civil penalty of $500 will be assessed for the lack of supervision.

LPAs observed the children napping on mats with exposed foam and duct tape. In addition, LPAs learned that their is a new director on the premises and the Department was not notified with required paperwork to ensure the director is qualified.

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) 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.

Exit interview.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2022
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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Document Has Been Signed on 04/18/2022 04:58 PM - It Cannot Be Edited


Created By: Veronica Wheatley On 04/18/2022 at 02:54 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: SHIRAYURI YOUCHIEN
FACILITY NUMBER: 197414787

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/19/2022
Section Cited
CCR
101229(a)(1)

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101229(a)-Responsibility for Providing Care and Supervision- The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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The licensee agrees to ensure that children are supervised at all times. Children will be supervised when going to the restroom. The licensee will submit a plan of correction to the Department by 4/19/22.
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This requirement was not met as evidenced by: LPAs Wheatley and Casillas observed Child #1 inside of the restroom unsupervised by staff/teacher. The teacher could not see the child from the classroom. Also, LPAs observed 3 children from the playground go the restroom unsupervised. This is an immediate risk to the health and safety of children 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.
SUPERVISOR'S NAME:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2022


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 04/18/2022 04:58 PM - It Cannot Be Edited


Created By: Veronica Wheatley On 04/18/2022 at 03:47 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: SHIRAYURI YOUCHIEN
FACILITY NUMBER: 197414787

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2022
Section Cited
CCR
101239.1(b)(5)

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101239.1(b)(5) -Napping Equipment
Floor mats used for napping shall be:
(5) Maintained in a safe condition with no exposed foam.
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Licensee agrees to throw away the napping mats with exposed foam and purchase new mats. Licensee will submit a plan of correct and picture of new mats by 4/25/22.
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This requirement was not met as evidenced by:
LPAs Wheatley and Casillas observed children napping on mats with exposed foam. This is a potential risk to the health and safety of children in care.
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Type B
04/25/2022
Section Cited
CCR101239.1

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101239.1- Napping Equipment -Each cot or mat shall be equipped with a sheet to cover the cot or mat and, depending on the weather, a sheet and/or blanket to cover the child.
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Licensee agrees to use sheets on each napping mat during use and purchase extra sheets in case the parents forget to bring for the children. Licensee will submit a plan of correct and picture of new mats by 4/25/22.
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This requirement was not met as evidenced by:
LPAs Wheatley and Casillas observed children napping on mats without a sheet covering the mat. This is a potential risk to the health and safety of children 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.
SUPERVISOR'S NAME:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2022


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/18/2022 04:58 PM - It Cannot Be Edited


Created By: Veronica Wheatley On 04/18/2022 at 03:54 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: SHIRAYURI YOUCHIEN
FACILITY NUMBER: 197414787

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2022
Section Cited
CCR
101212(b)

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101212(b) - Reporting Requirements-The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).
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Licensee submitted the required director's paperwork to LPAs for review for the new director Hiroko Kozuchi as a POC during the inspection today. The file will be sent via email to LPA Wheatley.
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This requirement was not met as evidenced by:
LPAs Wheatley and Casillas observed a new director Hiroko Kozuchi on the premises today. The Department has not received formal notification and required documentation with the new director's qualifications. This is a potential risk the health and safety to children 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.
SUPERVISOR'S NAME:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2022


LIC809 (FAS) - (06/04)
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