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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400231
Report Date: 05/01/2024
Date Signed: 05/01/2024 03:09:16 PM

Document Has Been Signed on 05/01/2024 03:09 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: 6DATE:
05/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Facility RepresentativesTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 05/01/2024 Licensing Program Analyst (LPA) Katrina Chicote arrived at the above facility for the purpose of a Case Management - Incident inspection to follow up on an incident that was reported to Department on 04/17/2024. LPA announced purpose of inspection and was granted entry to facility by S1. LPA took a tour of facility indoors and census was taken. LPA observed six infants in care with three infants napping on cribs and one on a standard blue cot.

On 04/17/2024, facility reported an incident where an infant sustained an injury allegedly requiring medical. Facility reported incident within 24 hours of notification and written report within seven days. Per report, infant arrived with a spider bite on his head and child was accepted into care but spider bite was not documented. Infant's Authorized Representative inquired about an injury observed on the child during pick up time to which facility stated that there was no incident observed that could have caused an injury to the head. On 04/16/2024, facility was notified by infant's Authorized Representative that infant was admitted into hospital due to blood clots on the head and concussion. Per report, facility suspended staff for failure to document spider bite in the morning and video footage was reviewed and no incidents were observed regarding infant that could have caused injuries reported by Authorized Representative. Per Facility Representative, no medical reports were provided by infant's Authorized Representative in regards to alleged medical injuries that they are reporting.

LPA obtained Facility Roster and notified Facility Representatives that incident is being investigated by Licensing's Investigation Branch if further action is necessary.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today, 05/01/2024.

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 Representative, Peyton Solomon.
Report Ends - Page 1 of 1

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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