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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417299
Report Date: 04/04/2025
Date Signed: 07/02/2025 08:51:57 AM

Document Has Been Signed on 07/02/2025 08:51 AM - 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:UCLA WESTWOOD CHILD CARE CENTERFACILITY NUMBER:
197417299
ADMINISTRATOR/
DIRECTOR:		NICOLE FIORELLAFACILITY TYPE:
830
ADDRESS:10861 WEYBURN AVENUE #301TELEPHONE:
(310) 481-0664
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY: 63TOTAL ENROLLED CHILDREN: 58CENSUS: 48DATE:
04/04/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:46 PM
MET WITH:Assistant Director Ann BairesTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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An unannounced Case Management-Incident inspection was conducted on this date by Licensing Program Analyst (LPA) Amelia Morales. Upon arrival, LPA was greeted by Assistant Director Ann Baires, to whom the purpose of the visit was announced.

LPA observed the following classroom ratios: Room #A1: there were 7 children with two staff; room #A2: 10 children with three staff; room #L1: 8 children with 2 staff; room #L2: 4 children with one staff; room #L3: 8 children with two staff, room #L4: with 11 children with three staff.

The incident that occurred on 03/06/25 was reported to the Department via telephone on 03/07/2025. The incident, which occurred, child #1 chipped their tooth on green turf.

During staff interviews LPA was informed that Staff #1 and Staff #2 had active supervision of the child who obtained an injury. Staff #1 was behind Child #1 and Staff #2 was in front of Child #1. LPA Morales was informed by Staff #2, that Child #1 "stumbled" on themselves. Both staff members informed LPA Morales that at the time of the occurrence there was no child near Child #1, where Child #1 could have been pushed. When asked if their was anything in Child #1 path, Staff #1 stated there was nothing in Child #1 path.

Staff #1 explained that they checked on Child #1, and noticed Child #1 spit a part of the tooth. Staff #2 informed LPA that Staff #2 washed Child #1 face, and notified Administration of the incident. LPA Morales inspected where the incident occurred, there was cushioning material.
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NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: UCLA WESTWOOD CHILD CARE CENTER
FACILITY NUMBER: 197417299
VISIT DATE: 04/04/2025
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During the inspection, LPA obtained a copy of the children's roster, and conducted interviews with Staff #1, Staff #2, Assistant Director, obtained copy of staff #1 Origami written report, took photos and made observations of the green turf, where the incident occurred.

Based on all information obtained on this date, and interviews conducted with staff, the incident appears to be an unusual incident. There were no deficiencies observed in regards to todays visit.

Notice of Site was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Ann Baires.














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NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC809 (FAS) - (06/04)
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