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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415364
Report Date: 04/24/2024
Date Signed: 04/24/2024 02:59:57 PM

Document Has Been Signed on 04/24/2024 02:59 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SOUTH BAY UNIVERSAL CHILD DEVELOPMENT CENTERFACILITY NUMBER:
197415364
ADMINISTRATOR/
DIRECTOR:		SUSAN TALEBIANFACILITY TYPE:
850
ADDRESS:14025 CORDARY AVENUETELEPHONE:
(310) 970-0435
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 16DATE:
04/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:SUSAN TALEBIAN, DIRECTORTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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On 4/24/2024, Licensing Program Analyst (LPA) Loyce Phillips, conducted a case management inspection to follow up on an Unusual Incident, reported to the department by telephone on 4/10/2024. LPA was greeted by Director, Susan Talebian. LPA toured the facility and took a census of the children. LPA observed 16 children in care with 3 staff members.

Description of the incident: On 4/8/2024 at approximately 10:50am, during outside playtime C1 was accidentally pushed by C2. C1 landed on matted area putting her body weight on her hands causing her right arm to swell up. S1 notified Director regarding C1 incident and immediately went inside the classroom and applied an ice pack. Parent was notified at approximately 10:57am. Parent arrived right away to the facility and transported C1 to Little Mary Medical Center where she was referred to the Orthopaedic Institute for Children - Urgent Care Center. On 4/9/2024, Parents informed the Director that C1 was waiting on x-ray results. On 4/10/2024 the parents arrived to the facility at 12:00pm with doctors note regarding restrictions and C1 had a cast on her right arm. On 4/11/2024, C1 returned back to the facility with restrictions.

During this inspection, LPA toured the facility, interviewed staff, obtained pertinent documents, a copy of the facility roster and inspected and took photos of the outdoor play area.

Based on the information provided and interviews conducted further investigation is required.

An exit interview was conducted, a copy of this report and notice of site visit was provided to Director.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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