197403507-5-22-2019-30-CC-CGAN-BCET2W-20190522142122

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197403507
Report Date: 05/22/2019
Date Signed: 05/22/2019 02:21:30 PM

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:	GUBANI FAMILY DAY CARE		FACILITY NUMBER:	197403507
ADMINISTRATOR:	GUBANI, SMADAR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 954-8528
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	14	CENSUS: 0	DATE:	05/22/2019
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Smadar Gubani		TIME COMPLETED:	02:30 PM

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A Supervisory Conference was scheduled in the El Segundo Child Care Regional Office on May 22, 2019. The meeting attendees are as follows:

1. Sharalyn Jenkins-Sweeten, Licensing Program Manager

2. Christopher Garlington, Licensing Program Analyst

3. Ms. Smadar Gubani, Licensee

The purpose of this scheduled Supervisory Conference is to address departmental concerns regarding the Licensees’ ability to remain in substantial compliance based upon Type A deficiencies cited at the facility within the past three years.

The El Segundo Child Care Regional Office acknowledges the licensee’s corrections to all deficiencies and wishes to provide additional support to the licensee to promote and maintain compliance by fostering an ongoing partnership with the licensee through recommended resources, referrals and increased monitoring as follows:

1. Licensee agree(s) to remain in substantial compliance and operate the facility according to the Laws, Rules and Regulations, specifically noted for Family Child Care Home Regulations.

2. Licensee agrees to attend the Family Child Care Orientation on June11, 2019 at 8:30 AM at the El Segundo Child Care Regional Office. Upon completion of the orientation, licensee is to immediately submit the orientation certificate to LPA.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Christopher Garlington	TELEPHONE: (424) 301-3056
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GUBANI FAMILY DAY CARE	FACILITY NUMBER: 197403507
	VISIT DATE: 05/22/2019

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3. Licensee agrees to view Child Care Provider Videos and provide a declaration acknowledging completion no later than 06/21/2019. Video link https:

FCC- https://ccld.childcarevideos.org/family-child-care-providers/

Note: Licensee will submit a signed declaration stating review of Child Care Videos including dates and topics.

5. Licensee agrees to subscribe to the Child Care Quarterly Updates Child Care Advocates Program by submitting their email address in an email to childcareadvocatesprogram@dss.ca.gov or by phone number: (916) 654-1541.

6. Licensee agrees to subscribe to Provider Information Notices (PINs) at http://www.cdss.ca.gov/inforesources/Community-Care-Licensing/Policy/Provider-Information-Notices/Child-Care.

7. The facility has been placed on increased monitoring for Required Inspections annually..

A copy of this report was explained and issued to the Licensee, Ms. Smadar Gubani along with a copy of the Child Care Quarterly Update (Winter 2018 and Spring 2019), Provider Information Notices (PINS); Safe Sleep Awareness Campaign and Notification of New Regional Offices, as well as a list of child care videos for family child care providers designated to be viewed.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Christopher Garlington	TELEPHONE: (424) 301-3056
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019

LIC809 (FAS) - (06/04)

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