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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400231
Report Date: 09/27/2024
Date Signed: 12/24/2025 12:32:13 PM

Document Has Been Signed on 12/24/2025 12:32 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 BLOCK INFANT CENTERFACILITY NUMBER:
198400231
ADMINISTRATOR/
DIRECTOR:		PEYTON SOLOMONFACILITY TYPE:
830
ADDRESS:2141 W JEFFERSON BLVDTELEPHONE:
(323) 732-5439
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 4DATE:
09/27/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Peyton SolomonTIME VISIT/
INSPECTION COMPLETED:
02:30 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 9/27/24 at 1:00 PM Licensing Program Analyst (LPA) Claudia Kam and Joshua Ortega conducted an Unannounced Complaint Inspection for the purpose of delivering findings for the above allegations that were investigated by Department’s Investigation Branch (IB). LPA announced purpose of inspection and was granted entry by Facility Representative (FR), Peyton Solomon. Census was taken.

During the course of investigation, IB Investigator Spindola conducted interviews, obtained pertinent records such as medical records and video footage, and made observations at the facility. Medical record confirms that infant was taken to the Emergency on the same date an Unusual Incident Report (UIR) was received by the Department, 4/12/2024. Per medical record, infant was diagnosed with a traumatic hematoma of the forehead. A head contusion was also documented on the medical record which states that this injury happens when there is a blow to part of the body that causes injury under the skin. FR states that parent informed that infant sustained multiple blood clots, two black eyes and concussion which in inconsistent with medical report. Per video footage review, on the morning of incident, 4/12/2024, infant arrived at the facility with no large bump on forehead. Video footage reveals that at 8:41 AM, infant was forcefully pushed from behind, by another infant, onto the unprotected spindles of one of the facility’s cribs. Video footage also reveals that infant sustained a few additional falls throughout the day. At 9:10 AM, 9:12 AM, and 9:14 AM, infant was observed tumbling on his side trying to get out of his low high chair. Investigator also observed that surface of infant floor is concrete with vinyl flooring that is partially covered with thin carpets. Per Staff statements, they assumed the visible bump on infant’s forehead was due to a spider bite. FR states parent informed staff at drop off infant had a spider bite on the forehead. A spider bite is inconsistent with medical diagnoses and video footage observed. All staff stated they did not observe the child fall or hit his head on 4/12/24. Per UIR submitted and FR statements, they reviewed video footage and did not observe infant fall which, per Investigator Spindola’s observation of video footage, is not an accurate observation of video footage.

Page 1 of 2

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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 4
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 BLOCK INFANT CENTER
FACILITY NUMBER: 198400231
VISIT DATE: 09/27/2024
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
Per FR the staff in the classroom the day of the incident are no longer working at the facility as of 7/26/24. Based on the available information facility did not provide adequate supervision which resulted in child sustaining a severe injury in care requiring medical and Facility Staff failed to accurately report information observed on the video.

The following citations are being cited today on the attached LIC 9099D.

LPA Kam informed director Peyton Solomon that this report dated 9/27/24 document(s) two (2) Type A citation(s) which shall be posted for 30 consecutive days as there are immediate risk(s) to the health, safety, or personal rights of children in care. A violation regarding Care and Supervision warrants an immediate civil penalty of $500 and is hereby assessed, see LIC 421IM or other form used. Civil penalty is pending determination, per Health and Safety Code Section 1597.58(f).




Also, LPA Kam informed the director Peyton Solomon to provide a copy of this licensing report dated 9/27/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), XXXXX.

Page 2 of 2

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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 BLOCK INFANT CENTER
FACILITY NUMBER: 198400231
VISIT DATE: 09/27/2024
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
Type A: 1596.8897(a)(2)Employee Exclusion Actions, Prohibited positions or employment; grounds; notice; removal; appeal; petition for reinstatement. Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual…This requirement is not met as evidenced by:

Based on CCLD IB investigation, the Licensee did not meet the above regulation by failing to accurately report contents of video footage showing that infant sustained head injury while in care. This poses an immediate health, safety, and personal rights risk to children in care.

Page 3 of 3

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/27/2024 02:26 PM - It Cannot Be Edited


Created By: Claudia Kam On 09/27/2024 at 01:05 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: 09/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/27/2024
Section Cited
HSC
101429(1)(a)

1
2
3
4
5
6
7
101429 Responsibility for Providing Care and Supervision for Infants (a) In addition to Section 101229, the following shall apply:(1)Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. This regulation was not met as evidenced by:
1
2
3
4
5
6
7
DIrector will conduct a staff training regarding protocol for daily health check and proceedures for check in of child to be completed by 10/10/24. A barrier will be installed to separate the classroom from the infant sleep area.
8
9
10
11
12
13
14
Based on CCLD IB investigation, the Licensee did not meet the above requirement by an infant sustaining a severe injury while in care requiring medical that was not observed by Staff. This poses an immediate health, safety, and personal rights risk to children in care.
8
9
10
11
12
13
14
Request Denied
Type A
09/27/2024
Section Cited
CCR1596.8897(a)(2)

1
2
3
4
5
6
7
1596.8897(a)(2)Employee Exclusion Actions, Prohibited positions or employment; grounds; notice; removal; appeal; petition for reinstatement. Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual…This requirement is not met as evidenced by:
1
2
3
4
5
6
7
DIrector will conduct a staff training regarding protocol for incidents and accidents and daily reports by 10/10/2024.
8
9
10
11
12
13
14
Based on CCLD IB investigation, the Licensee did not meet the above regulation by failing to accurately report contents of video footage showing that infant sustained head injury while in care. This poses an immediate 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:Claudia Kam
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2024


LIC809 (FAS) - (06/04)
Page: 4 of 4