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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400231
Report Date: 03/07/2023
Date Signed: 03/17/2023 05:13:27 PM

Document Has Been Signed on 03/17/2023 05:13 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:NU BUILDING BLOCK INFANT CENTERFACILITY NUMBER:
198400231
ADMINISTRATOR:PEYTON SOLOMONFACILITY TYPE:
830
ADDRESS:2141 W JEFFERSON BLVDTELEPHONE:
(323) 732-5439
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 8DATE:
03/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Peyton Solomon, Facility RepresentativeTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced annual inspection on 3/7/23 at 9:45 AM. LPA initially met with Brenda Flowers, Staff One (S1). There were eight infants and three staff when LPA arrived. LPA was met by Peyton Solomon, Facility Representative (FR) at 10:20AM.

This is an infant program which consists of one classroom. Facility operation hours are Monday - Friday, 6AM to 6PM. This facility also has a neighboring Preschool component, facility #197416279 and school-age component #197416358 down the street at 2313 West Jefferson.

Facility is in compliance with license capacity and Title 22 ratio guidelines. All individuals present have obtained a criminal record clearance. Classroom was observed to ensure that infants are never left unattended.

LPA observed required posted documentation in the main entrance, which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, menu, and LIC 613A- Personal Rights.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster Plan. Per FR, a disaster drill has not been conducted in the last six months. LPA reviewed Sign In/Out sheets. Sign in/out is done electronically through Bright Wheel. Sign in sheets can be printed as needed. All children present were signed in with date, time and full signature of guardian.



Indoor space is physically separate from other child care components. Toys were observed to be safe, and do not have sharp points, edges, splinters and are not made of small parts that can pose a choking hazard. LPA observed paint chipping from a low ledge at the children's level. LPA did not observe any baby walkers or any ----------------PAGE 1
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2023
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NU BUILDING BLOCK INFANT CENTER
FACILITY NUMBER: 198400231
VISIT DATE: 03/07/2023
NARRATIVE
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Outdoor space is physically separate from other child care components. Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. LPA observed required shade in the outdoor area. LPA did not observe hazards in the outdoor space. LPA did not observe any bodies of water or firearms during this visit.

Children’s records were reviewed at for Immunization Records, Licensing Form (LIC) 627- Consent for Medical Treatment, LIC 700- Identification and Emergency information, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, LIC625- Needs and Service Plan, LIC 9227 Infant Sleep Plan, 15 minute check document and signed Admissions Agreement. All forms were observed. Needs and Service Plan was discussed.



Staff records were reviewed at for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 503- Health Screening, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse, Transcripts or Permit and current Mandated Reporter Training Certificate. LPA observed that two staff in the classroom do not have infant units. Per FR they are not left alone with the children. All other documents observed.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) 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. ----Page 3

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
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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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NU BUILDING BLOCK INFANT CENTER
FACILITY NUMBER: 198400231
VISIT DATE: 03/07/2023
NARRATIVE
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items that fall into that category present in the facility. All materials and surfaces accessible to children are toxic free. Classroom was inspected to ensure that the floors have a surfaces that are safe and clean.

Children have their own cubby to store their belongings. Cribs were observed in the classroom. LPA observed that seven cribs have broken wheels or are off balance, which poses a safety risk to children. Facility uses a movable barrier to separate nap area from play area. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the cribs. LPA observed a hanging heater in the nap area. LPA reminded FR that a crib cannot be placed under the heater. There are currently children with pacifiers. During nap LPA observed an infant with a pacifier connected to their clothing. Staff immediately removed object connecting pacifier to clothing. Per FR wet or soiled sheets are as needed throughout the day. Each infant has their own crib labeled with their name and bedding. Bedding is washed by facility and changed daily. LPA observed that infant changing table has a padded surface no less than one-inch-thick and it is covered with washable vinyl or plastic. The infant changing tables have raised sides that are at least 3 inches high. LPA observed that infant changing tables are within an arm’s reach of a sink. Toilet training is not offered at this program.

Telephone service, heating, lighting and ventilation were evaluated and are in operating condition. Disinfectants, cleaning solutions, and other items that are dangerous to children, were observed to be inaccessible. There are no children currently with medication. FR states that there are no poisons stored at the facility and understands that storage areas for poisons must be locked with a key or combination lock. Carbon monoxide detector is wired with smoke and fire alarm..

The facility provides AM snack, lunch and PM snack for children who eat solid food. Bottles, dishes, and containers of food brought by the infant’s authorized representative are labeled with infant’s name and the current date. All food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers at 45˚ (F) or less. --------------------------PAGE 2

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC809 (FAS) - (06/04)
Page: 8 of 8
Document Has Been Signed on 03/17/2023 05:13 PM - It Cannot Be Edited


Created By: Denise Gibbs On 03/07/2023 at 01:27 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 BLOCK INFANT CENTER
FACILITY NUMBER: 198400231

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on Interview, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2023
Plan of Correction
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Per FR, they will conduct a drill on Monday and email drill log to LPA by POC date 3/31/23.
Type B
Section Cited
CCR
101239(n)
Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Seven cribs have broken wheels and are unbalanced, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2023
Plan of Correction
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Per FR, cribs will be fixed as soon as possible and an photo will be emailed to LPA by POC date 3/31/23
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:Karen Chambers
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 03/17/2023 05:13 PM - It Cannot Be Edited


Created By: Denise Gibbs On 03/07/2023 at 01:27 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 BLOCK INFANT CENTER
FACILITY NUMBER: 198400231

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Paint is chipping on a low barrier at the children's level, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2023
Plan of Correction
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Per FR, the area on the ledge will be covered up and painted. FR will send pictures of painted ledge by POC date 3/31/23
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:Karen Chambers
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


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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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NU BUILDING BLOCK INFANT CENTER
FACILITY NUMBER: 198400231
VISIT DATE: 03/07/2023
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Facility representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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

Exit interview conducted and report was reviewed with the Facility Representative Peyton Solomon..

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC809 (FAS) - (06/04)
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