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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601484
Report Date: 10/01/2026
Date Signed: 10/01/2026 02:33:00 PM

Document Has Been Signed on 10/01/2026 02:33 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:UCLA EARLY CARE AND EDUCATIONFACILITY NUMBER:
191601484
ADMINISTRATOR/
DIRECTOR:		MINOR, ALICIAFACILITY TYPE:
850
ADDRESS:101 S Bellagio DrTELEPHONE:
(310) 825-5086
CITY:Los AngelesSTATE: CAZIP CODE:
90095
CAPACITY: 122TOTAL ENROLLED CHILDREN: 57CENSUS: 52DATE:
10/01/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:36 AM
MET WITH:Arpine Panosyan, DirectorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 10/01/2026 at 10:36 a.m., Licensing Program Analyst (LPA) DeCondia Ferguson conducted an unannounced Case Management – Incident inspection at UCLA Early Care and Education Krieger Center to follow up on an Unusual Incident Report (UIR) received by the Department on 09/21/2026 regarding an incident that occurred on 09/17/2026. The UIR reported that Child #1 (C1) sustained an injury to the head while near the classroom cubby area. The UIR indicated that C1 reportedly struck C1's head on the wooden cubbies and that neither Staff #1 (S1) nor Staff #2 (S2) visually observed the incident.

The facility reported that following the incident, ice was applied to C1's head, Director #1 (D1) assessed C1, 911 and C1's parent were contacted, and paramedics responded to the facility and evaluated C1. Parent #1 (P1) subsequently arrived at the facility, signed an Against Medical Advice (AMA) waiver, and took C1 from the facility.

Upon arrival, LPA met with Director Arpine Panosyan, to whom the purpose of the inspection was announced. The Director guided LPA on a tour of the facility, during which a census was conducted. LPA observed 21 children with six staff in the Ducks classroom, 20 children with four staff in the Owls classroom, and 11 children with three staff in the Flamingos classroom.

During today's inspection, LPA interviewed S1, S2, D1, and C1 regarding the circumstances surrounding the incident. S1 stated that at the time of the incident, S1 was positioned at a table near the cubby area working with a group of children. S1 did not observe the incident but became aware of it when C1 approached S1 crying and stated that C1 had hit C1's head on the cubbies. S1 stated no other child or staff reported witnessing the incident. S1 comforted C1, obtained ice for C1's head, and took C1 to S2. S1 reported observing no hazards on the floor or around the cubby area and stated that the cubbies were secure and in good condition.

Raul Navarro
Decondia Ferguson
DATE: 10/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2026
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 EARLY CARE AND EDUCATION
FACILITY NUMBER: 191601484
VISIT DATE: 10/01/2026
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S2 stated that immediately prior to the incident, S2 was positioned toward the back door of the classroom and instructed the children that it was time to clean up. According to S2, C1 was among the children who got up and proceeded toward the cubbies. S2 stated that while assisting other children with clean-up, S2 heard C1 crying. S2 did not witness the incident. S2 stated that C1 subsequently showed S2 the cubby and reported bumping C1's head on the edge of the wooden portion of the cubby. S2 stated that when asked whether C1 had tripped, C1 responded that C1 had not. S2 reported observing a lump forming on the right side of C1's head with bruising that appeared blue and purplish. S2 applied an ice pack, and support staff assisted C1 while S2 contacted P1. S2 stated that the floor and cubby area were clear of hazards and that the cubbies were stable and in good condition.

D1 stated that D1 was informed that C1 had injured C1's head on the cubbies and that no staff witnessed the incident. D1 stated that staff had assumed C1 fell. Upon assessing C1, D1 observed a large bump on the right side of C1's head and an elevated vein. D1 stated that due to the significance and location of the head injury, D1 contacted 911 approximately five minutes after being notified and contacted P1 approximately one minute thereafter. Paramedics responded and evaluated C1 in D1's office. According to D1, paramedics recommended transport for further evaluation; however, P1 arrived and signed an AMA waiver. D1 stated that the cubby area was inspected following the incident, no hazards were identified, and the cubbies were secure and in good condition.

LPA interviewed C1 regarding the incident. C1 stated that C1 "bumped my head on the cubbies" and identified the cubby area as the location where the injury occurred. When asked whether C1 fell, C1 shook C1's head indicating no. C1 identified the right side/temple area of C1's head as the area that was injured. C1 stated that no one was near C1 and no one witnessed the incident. When asked whether another child bumped, pushed, or touched C1, C1 shook C1's head indicating no. C1 reported receiving an ice pack following the incident.

During today's inspection, LPA obtained and reviewed documentation related to the incident, including the accident/injury report, children's roster/census and sign-in record for 09/17/2026, staff schedule/roster for the classroom, photographs of the cubby area and classroom, C1's injury, and available paramedic/AMA documentation.

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026
LIC809 (FAS) - (06/04)
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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 EARLY CARE AND EDUCATION
FACILITY NUMBER: 191601484
VISIT DATE: 10/01/2026
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The investigation remains ongoing. LPA will conduct additional follow-up, including an interview with P1, prior to making a determination regarding this incident. A follow-up inspection may be conducted as necessary to complete the investigation. No deficiencies are being cited during today's inspection regarding this incident.

An exit interview was conducted and the report reviewed with Director Arpine Panosyan.

A copy of this report was provided along with appeal rights.

Notice of Site was provided and must be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026
LIC809 (FAS) - (06/04)
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