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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407183
Report Date: 12/12/2023
Date Signed: 12/12/2023 05:16:28 PM

Document Has Been Signed on 12/12/2023 05:16 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SEIAI YOCHIENFACILITY NUMBER:
197407183
ADMINISTRATOR:AKI FUJIMURAFACILITY TYPE:
850
ADDRESS:25506 NARBONNE AVENUETELEPHONE:
(310) 530-0049
CITY:LOMITASTATE: CAZIP CODE:
90717
CAPACITY: 43TOTAL ENROLLED CHILDREN: 43CENSUS: 6DATE:
12/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Aki Fujimura, DirectorTIME COMPLETED:
05:36 PM
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On 12/12/2032 @ 3:45 PM, Licensing Program Analyst (LPA) Miriam Cohen conducted a Case Management Unusual Incident inspection to follow up on the self-reported incident that occurred on 12/05/2023 at Seiai Yochien. The El Segundo Regional Office received the incident report on 12/07/2023. Upon arrival, LPA observed five staff members supervising six preschoolers. LPA interviewed and obtained written statement from staff members who were present during the incident. Per director, the victim child (C1) was released from the hospital, after surgery, on 12/07/2023 and visited the preschool with parents on Friday 12/08/2023. The director received information from parent that C1 will visit with bone specialist in the coming weeks.

Based on the information that were gathered through interviews, observation of physical plant, and consultation with management, further investigation is warranted including interviews with C1 and parent of C1 upon return to preschool.

The content of this report was read and discussed in detail with preschool director, Aki Fujimura.
An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2023
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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