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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494727
Report Date: 07/19/2024
Date Signed: 07/19/2024 01:56:55 PM


Document Has Been Signed on 07/19/2024 01:56 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:BUMO - CENTURY CITYFACILITY NUMBER:
197494727
ADMINISTRATOR:DARLENE DAVIS-AYALAFACILITY TYPE:
850
ADDRESS:10250 SANTA MONICA BLVD. #2860TELEPHONE:
(909) 648-6954
CITY:LOS ANGELESSTATE: CAZIP CODE:
90067
CAPACITY:14CENSUS: 9DATE:
07/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Center Manager / Justin PelenTIME COMPLETED:
02:15 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 7/19/24, at 1PM, Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced Case Management Visit to this facility. LPA met with Center Manager / Justin Pelen, who guided LPA on a tour of the facility. There were 9 children with 3 staff observed present.

During a cite visit conducted on 7/19/24, LPA Katrdzhyan discovered that facility staff failed to report an incident to CCL that occurred a few weeks ago (date unknown), involving Child 1. During interviews conducted, it was disclosed that Child 1 was left inside the Blue Room unattended, with no staff supervision for approximately 5 - 8 minutes. The incident happened around nap time, between 12:30PM - 12:45PM, as staff were preparing the children for a nap.

During today's visit, the Center Manager was asked to submit an Unusual Incident/Injury Report to CCL by no later than the end of business day on 7/19/24, regarding the incident involving Child 1.

The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22.

The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Justin Pelen and Appeals Rights provided.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2024
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 2


Document Has Been Signed on 07/19/2024 01:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: BUMO - CENTURY CITY
FACILITY NUMBER: 197494727

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2024
Section Cited
CCR
101212(d)(1)(C)

1
2
3
4
5
6
7
Reporting Requirements. Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
1
2
3
4
5
6
7
The Director will review Title 22, Regulation Section 101212 / Reporting Requirements and conduct an in-service training with all staff on the importance of ensuring compliance within this section. Copies of the training along with signatures of all attendees will be submitted to CCL by the POC due date
8
9
10
11
12
13
14
Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement is not being met as evidenced by: LPA discovered that facility staff failed to report an incident to CCL that occurred a few weeks ago (date unknown), involving Child 1. During interviews conducted, it was disclosed that Child 1 was left inside the Blue Room unattended, with no staff supervision for approximately 5 - 8 minutes. The incident happened around nap time, between 12:30PM - 12:45PM, as staff were preparing the children for a nap. This poses a potential health, safety, and personal rights risk to children in care.
8
9
10
11
12
13
14
of 8/2/24.

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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2