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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415364
Report Date: 12/04/2024
Date Signed: 12/04/2024 10:48:58 AM

Document Has Been Signed on 12/04/2024 10:48 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
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: 20DATE:
12/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:SUSAN TALEBIAN, DIRECTORTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 12/4/2024, 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 11/22/2024. LPA was greeted by Director, Susan Talebian. LPA toured the facility and took a census of the children. LPA observed 20 children in care with 3 staff members.

Description of the incident: On 11/21/2024 at approximately 1:40 to 1:50pm, during outside playtime Child 1 (C1) fell off the first step of the apparatus. As result C1 received a small open wound on his forehead. Staff 1 (S1) observed the incident and brought C1 inside the classroom and applied first aid. S1 and Director called parent and paramedics. The paramedics arrived to the facility and conducted an assessment on C1 and Parent decided to transport C1 to the Emergency Room. C1 received glue stiches to the wound and a medical note to return to school on 11/22/2024 with no restrictions. C1 returned to the facility on 12/2/2024.

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

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: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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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