197404345-8-18-2022-58-CC-JLAO-CHEUDA-20220818152914

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197404345
Report Date: 08/18/2022
Date Signed: 08/18/2022 03:29:45 PM

Document Has Been Signed on 08/18/2022 03:29 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:	PETLITSKAYA FAMILY CHILD CARE		FACILITY NUMBER:	197404345
ADMINISTRATOR:	PETLITSKAYA, LYUDMILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 625-7521
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	14	CENSUS: 13	DATE:	08/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Lydmila Petlitskaya		TIME COMPLETED:	03:30 PM

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On 8/18/2022 Licensing Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection and was met by Lyudmila Petlitskaya, Licensee. LPA observed 13 children in the home with 1 additional adult and licensee during the inspections. Days and hours of operation are Monday through Friday, 6:00 a.m. to 9:00 p.m.
Currently program does not enroll children under the age of 12 months. Currently, program offers care and supervision to children ages 2 years old to 6 years old.

LPA toured the home inside and outside and a census was taken. Home is a single story dwelling, 4 bedrooms, 3 bathrooms, living room, dining room, kitchen, laundry room and family room/day care room. Families access the family room/day care through the side of the home. Licensee confirmed the family room and bathroom near the family room are designated for the day care. All other rooms are OFF LIMITS and made inaccessible to the children. LPA reminded licensee that all doors that lead to the areas designated as off limits need to be closed and locked during the hours of operations.

The following areas of OFF LIMITS to the children in care:
Main entrance, living room, dining room, bedroom 1, bedroom 2, bedroom 3, bedroom 4, bathroom 1, bathroom 2 and kitchen and laundry room.

Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. No windows or doors have direct access to the pool area. Fire place was in the living room was observed to be barricaded with a metal gate.

There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible in the laundry sink cabinet- safety latch was observed.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: 424-301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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: PETLITSKAYA FAMILY CHILD CARE	FACILITY NUMBER: 197404345
	VISIT DATE: 08/18/2022

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There is a working fire extinguishers located in the laundry room outside the kitchen area. LPA observed licensee test the smoke detector, carbon monoxide detector in the home. Two smoke detectors and carbon monoxide located in the family room/day care space and one in the laundry room. Facility has adequate heating and ventilation for safety and comfort. Home has two steps outside the dining room area that led to the play room/family room.

Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 625-7521.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed children’s files and observed files were complete. Licensee’s Mandated Reporter Training was not available for review. Licensee agrees to submit proof of competition to LPA by 9/2/2022 via email. Licensee’s pediatric CPR/First Aid taken on 6/28/2021. A review of records indicates that all employees and/or volunteers have immunization records on file. Licensee will ensure all documents pertaining to children’s file and assistant’s file is complete. LPA discussed the LIC311D and provided a sample packet for reference.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Licensee prefers to communicate in Russian, but understand basic English.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: 424-301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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: PETLITSKAYA FAMILY CHILD CARE	FACILITY NUMBER: 197404345
	VISIT DATE: 08/18/2022

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Licensee was reminded that all adults 18 and over living or working in the home, 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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Lyudmila Petliltskaya.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: 424-301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC809 (FAS) - (06/04)

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