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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408786
Report Date: 08/12/2022
Date Signed: 08/12/2022 03:32:35 PM


Document Has Been Signed on 08/12/2022 03:32 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:ASERAF FAMILY CHILD CAREFACILITY NUMBER:
197408786
ADMINISTRATOR:ASERAF, TOMERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 450-7600
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:14CENSUS: 4DATE:
08/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Donna AserafTIME COMPLETED:
03:15 PM
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On 8/12/022 Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection and was met by Donna Aseraf.

Days and hours of operation are 8:30 a.m. to 5:30 p.m., Monday through Friday. Currently applicant cares for children ages 12 months to 3 years old.
LPA toured the home inside and outside and a census was taken; LPA observed 4 children with the licensee and her assistant. LPA was guided on a tour of the home inside and outside. There are two building structures on the property. The main home is a single story dwelling with 3 bedrooms, 2 ½ bathrooms, kitchen, living room and dining area. The childcare is primarily conducted in the detached building in the back that includes a bathroom and has an adjacent play area for the children. Licensee confirmed that children eat and nap inside the main home in the living areas and when inside, they use the first bathroom in the hallway. LPA received an LIC 855- Declaration stating that children nap and eat in the main living room.

The following areas are currently OFF LIMITS: The bedrooms and master bathrooms are OFF LIMITS to the children in care. LPA observed all doors closed during the hours of operations.

Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. The in ground pool is made inaccessible by a mesh fencing. The yard between the play area and the main home is completely fenced in. No windows or doors have direct access to the pool area.

The living room has a decorative fireplace that is not used- per license, fire place is not a working fire place. LPA received a declaration LIC 855 from licensee stating the fireplace is not working or in use.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: 424-301-3060
LICENSING EVALUATOR SIGNATURE:
DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2022
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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