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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494347
Report Date: 12/10/2024
Date Signed: 12/11/2024 08:17:41 AM

Document Has Been Signed on 12/11/2024 08:17 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BRELLA PLAYA VISTA - INFANTFACILITY NUMBER:
197494347
ADMINISTRATOR/
DIRECTOR:		KIMBERLY KERNFACILITY TYPE:
830
ADDRESS:12746 W. JEFFERSON BL. #3-3100TELEPHONE:
(424) 425-7500
CITY:LOS ANGELESSTATE: CAZIP CODE:
90094
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 29DATE:
12/10/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:32 PM
MET WITH:Kimberly KernTIME VISIT/
INSPECTION COMPLETED:
04:33 PM
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On 12/10/2024, Licensing Program Analysts (LPA) Ranita Richmond and Brittany Lovest conducted an unannounced Required / Annual Inspection for the above-named Infant Child Care Center. Center is licensed for 32 infant children, ages 3 months through 24 months. LPAs met with Director Kimberly Kern. LPAs Richmond and Lovest toured the facility indoors and outdoors and observed 29 children in care, being supervised and cared for appropriately by 9 fingerprint cleared staff members. Facility hours of operation are Monday – Friday, 8:00am – 5:00pm.

Facility has an approved outdoor waiver and LPAs observed waiver posted in the front lobby.



Capacity and limitations as specified on the license are being maintained.

During walk through at approximately 2:05pm in the Peach classroom S11 exited the infant sleep room, walking into the infant common area leaving 5 children unattended without visual supervision. Citation Cited. See LIC 809D.

The CCC is in compliance with Title 22 regulations regarding Staff to Student ratios. Facility is currently using online app (Pro Care). LPA Richmond advised Director of the importance of sign in/sign out using the full first and last name of the parent/authorized representative and time of checking the child in and out daily. LPA advised the director of the importance of having a hard copy available for review.

Facility is open to enroll children that might need medication administered. Medication, if needed, is stored in the locked cabinet in a locked container behind the reception desk. LPA reminded facility to ensure that all medication is stored with all necessary LIC forms. All prescription and nonprescription medication shall be centrally stored in accordance with the following requirements: medication shall be kept in a safe place inaccessible to the children in care, each container shall have an unaltered label. Assistant director confirmed that medication is stored in the reception cabinet. Currently facility does not have any children that need medication.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BRELLA PLAYA VISTA - INFANT
FACILITY NUMBER: 197494347
VISIT DATE: 12/10/2024
NARRATIVE
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There are no swimming pools, ponds, or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible to children in care.

LPA Richmond observed 3 (three) fully charged 2A:10B:C fire extinguisher in the hallway and inside the Peach class room. LPA Richmond observed working carbon monoxide and smoke detectors. Fire alarms are wired to the Pull Fire Alarm system. Fire alarm system and fire extinguishers last serviced in August 2024.

All toilets and hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. LPAs inspected the classrooms and observed age-appropriate toys, books and furnishings. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts.

No kitchen on site. Families provides all meals, snacks, and water. CCC provides water for refillable bottles. Solid waste storage containers have tight-fitting covers and are in good repair.

LPA reviewed 6 children’s files and observed files to be in compliance with current contact information for authorized representatives and/or relatives who can assume responsibility for the child, immunization records, and authorization for medical treatment. C3 and C5 files contained LIC 9227 forms that are missing signatures in section D. Citation cited. See LIC 809D. At approximately 2:39pm LPA reviewed Pro Care app. App shows the C5 is placed in a position other than back to sleep. Due to LIC 9227 on file being incomplete, C5 should only sleep on back. Citation cited. See LIC 809D.

LPA Laureano reviewed 10 personnel files. LPAs reminded Director that CPR/First Aid is to be EMSA approved and both CPR/First Aid and Mandated Reporter training are to be renewed every 2 years. LPAs provided director with LIC311A and LIC125 to use as a reference when auditing files.

CCC DID NOT COMPLETED LEAD TESTING due to building being built after 2010.



Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BRELLA PLAYA VISTA - INFANT
FACILITY NUMBER: 197494347
VISIT DATE: 12/10/2024
NARRATIVE
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This facility provides Incidental Medical Services - IMS.
LPA Richmond reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care­ centers/.


Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA Richmond reminded Director to access the Community Care Licensing website www.ccld.ca.gov for access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.


To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, citations were cited today. See LIC 809D

Exit interview conducted, and report was reviewed with Director Kimberly Kern.


Appeal rights printed and reviewed with Director Kimberly Kern.
A Notice of Site Visit was provided and must remain posted for 30 days.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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Document Has Been Signed on 12/11/2024 08:17 AM - It Cannot Be Edited


Created By: Ranita Richmond On 12/10/2024 at 03:57 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: BRELLA PLAYA VISTA - INFANT
FACILITY NUMBER: 197494347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101429(a)(1)
Responsibility for Providing Care and Supervision for Infants
(1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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4
Based on observation, the licensee did not comply with the section cited above in 1 of 1. Visual supervison to infants by staff at all times which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/24/2024
Plan of Correction
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Director will ensure all staff maintain visual supervison of infants at all times. Director will conduct staff meeting in regards to visual supervision.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Claudia Escobedo
LICENSING EVALUATOR NAME:Ranita Richmond
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/11/2024 08:17 AM - It Cannot Be Edited


Created By: Ranita Richmond On 12/10/2024 at 03:57 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: BRELLA PLAYA VISTA - INFANT
FACILITY NUMBER: 197494347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101430(a)(3)(A)(4)(a)
Infant Care Activities
(A) Staff shall place infants up to 12-months of age on their backs for sleeping. (4) Infants with an Individual Infant Sleeping Plan [LIC 9227 (3/20)] that have Section C of the form completed and signed by an authorized representative shall be placed on their back when first laid down to sleep. In the event the infant changes position, the infant may remain in the alternative position. (a) Upon staff observation that the infant is capable of rolling from their back to their stomach and stomach to their back, the provider shall fill out Section D of the Individual Infant Sleeping Plan [LIC 9227 (3/20)], notify the authorized representative, and obtain the authorized representative's signature on the individual sleeping plan no later than the next business day following observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 1 of 1. Infants under 12 months with incomplete LIC 9227 will not sleep in position other than their back which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/24/2024
Plan of Correction
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Director will review LIC 9227 with front desk and infant classroom staff to ensure procedures are followed correctly.

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:Claudia Escobedo
LICENSING EVALUATOR NAME:Ranita Richmond
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 12/11/2024 08:17 AM - It Cannot Be Edited


Created By: Ranita Richmond On 12/10/2024 at 03:57 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: BRELLA PLAYA VISTA - INFANT
FACILITY NUMBER: 197494347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.2(b)(2)
Infant Needs and Services Plan
(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 1of 1. LIC 9227 incomplete which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/24/2024
Plan of Correction
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Director will ensure staff and authorized representative signs LIC 9227 as needed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Claudia Escobedo
LICENSING EVALUATOR NAME:Ranita Richmond
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


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