<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416279
Report Date: 10/19/2023
Date Signed: 10/19/2023 03:13:26 PM

Document Has Been Signed on 10/19/2023 03:13 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:NU BUILDING BLOCKS DAY CARE CENTERFACILITY NUMBER:
197416279
ADMINISTRATOR:PAIGE SOLOMONFACILITY TYPE:
850
ADDRESS:2313 WEST JEFFERSON BOULEVARDTELEPHONE:
(323) 732-5439
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY: 58TOTAL ENROLLED CHILDREN: 0CENSUS: 39DATE:
10/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Paige Solomon & Yadira Godlock, DirectorsTIME COMPLETED:
03:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/19/2023 at 12:00 PM, Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Case Management - Other inspection to the above facility for the purpose of increased monitoring to the facility as a result of compliance issues and meeting conducted. Upon arrival, LPA disclosed the purpose of the inspection and initially met with Peyton Solomon, who guided the LPA on a tour of the facility both indoors and outdoors.

LPA observed three classrooms in use during inspection: PreK-2, PreK-3, PreK-4. LPA observed four staff (S1, S2, S3, and S4) with ten children in PreK-2, two staff (S5 and S6) with 13 children in PreK-3, and two staff (S7 and S8) with 16 children in PreK-4 . LPA observed children transitioning from outside play to nap time upon arrival. LPA observed cots laid out not obstructing walkways and entrances/exits. LPA observed uncleared adult, Connie Aragon (Staff #4), present at the facility and assisting in PreK-2 room. Per Director, individual is volunteer and has been present at the facility for about a month and stays from 11:00am to 4:00pm. LPA notified Director of uncleared status and observed individual leave facility during inspection.

LPA conducted file reviews for completion of necessary documents of all staff and six children's files present during today's inspection. Review of files were documented on LIC 857 for children and LIC 859 for staff. Children's records reviewed are complete. Upon review of staff files the following observations were made:

  • LIC 503 missing for 6 of 8 staff files.
  • Completion of current AB1207 Mandated Reporter missing for 4 of 8 staff files
  • Complete immunization (MMR, TdaP, & Influenza or written declination for this only) records for 6 of 8 staff files
  • Proof negative TB test for 4 of 8 staff files
  • Education verification for 2 of 8 staff files
    Report Continues - Page 1 of 2
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NU BUILDING BLOCKS DAY CARE CENTER
FACILITY NUMBER: 197416279
VISIT DATE: 10/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA observed a school age child (C7) present at facility initially in PreK-2 and then moved to the preschool program room upon entry of facility. LPA discussed observation with Facility Representatives and requirement that school age and preschool program cannot co-mingle and/or be present in each other's program. LPA observed C7 move to upstairs school age program supervised by a designated school age teacher during inspection.

LPA observed outdoor play area and observed surface of outdoor play area not maintained at time of inspection. LPA observed holes on two areas of cushioning material in outdoor play area and black play tiles. LPA discussed observation with Facility Representatives at time of inspection.

Directors, Paige Solomon and Yadira Godlock, arrived at a later time to continue inspection and conduct review of report.

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A civil penalty of $500 was assessed during this inspection for uncleared adult observed providing care to children.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Facility Representatives.


Report Ends - Page 2 of 2
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 10/19/2023 03:13 PM - It Cannot Be Edited


Created By: Katrina Chicote On 10/19/2023 at 02:06 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: NU BUILDING BLOCKS DAY CARE CENTER
FACILITY NUMBER: 197416279

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2023
Section Cited
HSC
1596.8662(d)(1)

1
2
3
4
5
6
7
1596.8662(d)(1) Health and Safety Code
a person...of a licensed child day care facility shall complete the mandated reporter training, complete renewal... every two years...
This regulation was not met as evidenced by:
1
2
3
4
5
6
7
Facility Representative (FR) states she will have staff submit current and correct AB1207 training. LPA will conduct visit to clear citation.
8
9
10
11
12
13
14
Based on LPA record review 4 of 8 staff did not proof of current required AB1207 Mandated Reporter on file at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
8
9
10
11
12
13
14
Type B
11/22/2023
Section Cited
CCR101216g(1)(2)(A)(B)

1
2
3
4
5
6
7
101216g(1)(2)(A)(B) Personnel Req
(g) All personnel,.. shall be in good health ... (1) shall be verified by a health screening, including a test for tuberculosis... (2) Each person specified in (g) above shall have a health-screening report...
This regulation was not met as evidenced by:
1
2
3
4
5
6
7
FR states she will obtain LIC 503 and TB tests and file. LPA will conduct visit to correct.
8
9
10
11
12
13
14
Based on LPA record review 6 of 8 staff files did not have LIC 503 in file, which includes 3 of 8 not having proof of tuberculosis test at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
8
9
10
11
12
13
14
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 10/19/2023 03:13 PM - It Cannot Be Edited


Created By: Katrina Chicote On 10/19/2023 at 02:20 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: NU BUILDING BLOCKS DAY CARE CENTER
FACILITY NUMBER: 197416279

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/02/2023
Section Cited
HSC
1597.622

1
2
3
4
5
6
7
1597.622 Health and Safety Code
...September 1, 2016, a person shall not
be employed..a family day care home if he
or she has not been immunized against
influenza, pertussis, and measles.

This regulation was not met as evidenced by:
1
2
3
4
5
6
7
FR states that she will review LIC 859 and have staff obtain records. LPA will conduct visit.
8
9
10
11
12
13
14
Based on record review, LPA did not observe complete immunization records for 6 of 8 staff present at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
8
9
10
11
12
13
14
Type B
11/02/2023
Section Cited
CCR101216.1(g)

1
2
3
4
5
6
7
101216.1 (g) Teacher Qualifications and Duties
(g) A photocopy of the teacher's Child Development Permit.. or a photocopy of the teacher's transcript(s) ...shall be maintained at the center.
This regulation was not met as evidenced by:
1
2
3
4
5
6
7
FR states that she will obtain education records and plcae in file. LPA will conduct visit.
8
9
10
11
12
13
14
Based on record review, LPA did not observe proof of education verification in 2 of 8 staff files at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
8
9
10
11
12
13
14
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 10/19/2023 03:13 PM - It Cannot Be Edited


Created By: Katrina Chicote On 10/19/2023 at 02:28 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: NU BUILDING BLOCKS DAY CARE CENTER
FACILITY NUMBER: 197416279

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/20/2023
Section Cited
CCR
102416(d)

1
2
3
4
5
6
7
102416(d) Personnel Requirements
Prior to employment or initial presence.. all employee...shall: (1) Obtain a California clearance or a criminal record exemption as required.... by Department..
This regulation was not met as evidenced by:
1
2
3
4
5
6
7
LPA observed individual leave premises during inspection. Written declaration obtained from FR that individual will not be present at the facility until cleared.
8
9
10
11
12
13
14
Based on LPA record review and observation, Connie Aragon, was assisting in PreK-2. FR states individual is volunteer that has been present at the facility for a month and from 11:00am to 4:00pm. This is an immediate health, safety, and personal rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 10/19/2023 03:13 PM - It Cannot Be Edited


Created By: Katrina Chicote On 10/19/2023 at 02:43 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: NU BUILDING BLOCKS DAY CARE CENTER
FACILITY NUMBER: 197416279

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2023
Section Cited
CCR
101238.2

1
2
3
4
5
6
7
d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned. (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.
This regulation was not met as evidenced by:
1
2
3
4
5
6
7
FR states they will fix hole replace broken black tile. LPA will conduct visit to correct POC.
8
9
10
11
12
13
14
Based on LPA observation, Licensee did not comply with above regulation. LPA observed cushioning material to have holes and black tiles to be broken which is a trip hazard. This poses a potential health, safety, and personal rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023


LIC809 (FAS) - (06/04)
Page: 6 of 6