197403507-10-18-2022-58-CC-ARIR-CKBUBS-20221018152648

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197403507
Report Date: 10/18/2022
Date Signed: 10/18/2022 03:27:06 PM

Document Has Been Signed on 10/18/2022 03:27 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:	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:	10/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Smadar Gubani, Licensee		TIME COMPLETED:	03:45 PM

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On 10/18/2022, Licensing Program Analyst (LPA) Adrian Risher conducted an Annual Inspection. LPA provided Licensee with the purpose of the visit and was granted access to the facility. LPA met with Smadar Gubani, Licensee. LPA observed the home to be clean, safe, orderly and well ventilated. There were no children in care due to religious holiday week. The operating hours are Monday thru Thursday 8-5pm & Friday 8am to 1pm

LPA observed the home to have a Living Room, Dining Room, Kitchen, 3 bedrooms, and 2 bathrooms. The Licensee utilizes the living room, dining room and guest house as the day-care. The rest of the home is inaccessible to the children. The living room and dining room are used for daily activities. The guest house is used for daily activities, eating and napping. LPA observed play pens and mats used for napping.

LPA observed age appropriate toys and equipment for the children. Licensee states that there are no weapons in the home. Licensee reports that there are no pets in the home. The kitchen and bathroom areas were inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects. These items were made inaccessible to children. Kitchen/bathroom drawers were made inaccessible to children.

LPA observed operable smoke detectors and carbon monoxide detectors throughout the home which were tested during inspection. The home is equipped with 1 (2-A:10-B:C) Fire Extinguisher and First Aid kit which includes thermometer, and band aids. Licensee CPR card expires 06/16/2023. LPA observed a screened fireplace. Licensee stated she uses portable heaters to keep the home warm. Licensee uses air conditioner and fans to keep the home cool.

LPA inspected the outside play area and observed age appropriate toys. There are no bodies of water at the home. The outside play area is fenced all around.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian Risher	TELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GUBANI FAMILY DAY CARE	FACILITY NUMBER: 197403507
	VISIT DATE: 10/18/2022

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Immunization record was reviewed. Mandated reporter training certificate was provided. Staff and children's files were reviewed. LPA reviewed records related to earthquake drills and fire drills. All required Child Care Postings was observed on the Parent Board during inspection.

No deficiencies will be cited

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

Incidental Medical Services(IMS) was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice(USDOJ) toll-free ADA information Line at (800) 514-0301(voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/child1qanda.htm

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian Risher	TELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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: GUBANI FAMILY DAY CARE	FACILITY NUMBER: 197403507
	VISIT DATE: 10/18/2022

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LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the licensee Smadar Gubani

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian Risher	TELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC809 (FAS) - (06/04)

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