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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415364
Report Date: 12/18/2024
Date Signed: 12/18/2024 04:10:25 PM

Document Has Been Signed on 12/18/2024 04:10 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:
12/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:SUSAN TALEBIAN, DIRECTORTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On 12/18/2024, Licensing Program Analysts 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. Licensing Program Analyst toured the facility and took a census of the children. Upon arrival during pm session, there were 16 children and 3 staff present today at the facility.

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 today's visit LPA interview C1 and parent of C1. LPA also observed children playing outside and around the play structure. LPA also provided best practices regarding the apparatus.

Based on the information obtained, interviews conducted and observations of the play yard area. C1 accidentally fell of the first step of the apparatus. As a result C1 received a small open wound on his forehead. C1 received glue stiches to the forehead. C1 has returned to the facility on 12/2/2024 with no restrictions. The facility had appropriate children/staff ratios during the incident, there were no equipment or objects on the step of the apparatus where C1 fell. The facility reported the unusual incident in a timely manner; therefore, no Title 22 violations have occurred, and no deficiencies cited. A notice of site visit was given and posted for 30 days. Exit interview conducted and report was reviewed with Director, Susan Talebian.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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