197409052-4-5-2024-58-CC-ECAO-D42VPN-20240405163700

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197409052
Report Date: 04/05/2024
Date Signed: 04/05/2024 04:37:17 PM

Document Has Been Signed on 04/05/2024 04:37 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:	GROZOV FAMILY CHILD CARE		FACILITY NUMBER:	197409052
ADMINISTRATOR:	GROZOV, EDITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 727-1255
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91324
CAPACITY:	14	CENSUS: 1	DATE:	04/05/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:13 AM
MET WITH:	Edith Grozov, Licensee		TIME COMPLETED:	04:55 PM

NARRATIVE

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Licensing Program Analysts (LPA) Elicia Calvillo conducted an unannounced annual required inspection to the above facility on 04/05/2024. LPA arrived at the facility at 11:13AM, identified self and met with Edith Grozov, Licensee who guided analyst on a tour of the inside and outside of the facility. LPA provided Licensee with a copy of the LIC 125 Entrance Checklist to help facilitate the inspection. Facility operation hours are Monday to Friday from 08:00 AM 06:00PM.

The family child care home is a one-story dwelling with living room, dining room, 3 bedroom, 3 bathrooms, kitchen, covered patio, and converted garage. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that converted garage, dining room, 1 bedroom, two bathrooms are used for providing care and are accessible to children. All other rooms are off-limits which consists of 2 bedrooms and 1 bathroom. All off limit rooms are made inaccessible by use of safety door knobs.

LPAs observed a swimming pool on the premises. There is a fence surrounding the pool. Licensee, Edith Grozov on the LIC 809 report that the fencing will remain in place whenever licensed care is provided, and so long as the fence makes the swimming pool inaccessible to children as determined by licensing staff.

There is a metal stake fenced pool; the fence is in good repair and completely surrounds the pool, is designed and installed so children could not remove any portion of it. LPA measured the fence and is at least five feet high, constructed so that it does not obscure the pool from view, is not easily climbable by children. LPA observed the gate swings toward the pool, does not self-close, does not self-latched and self-latching device is located on the top of the gate. There is direct access through a bedroom with a door leading to the pool, Licensee to use a child proof safety knob during child care hours to make room inaccessible.

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SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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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Document Has Been Signed on 04/05/2024 04:37 PM - It Cannot Be Edited

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: GROZOV FAMILY CHILD CARE	FACILITY NUMBER: 197409052
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(g)(5)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. (A)Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in that the pool gate does not swing away from the pool and does not self latch which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2024
	Plan of Correction
1 2 3 4	Licensee stated they will have the pool gate repaired so that the gate will swing away from the pool and self latch. Licensee will provide pictures or video showing the repairs and email to LPA by 4/19/2024.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/05/2024 04:37 PM - It Cannot Be Edited

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: GROZOV FAMILY CHILD CARE	FACILITY NUMBER: 197409052
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.3(a)(1)

Alterations to Existing Building or Grounds

(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (1) Conversion of a garage (either attached or detached) into a "child care" room. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, facility sketch (date 7/3/2002) record review, the licensee did not comply with the section cited above in that the garage has been converted to a sleeping room for children in care which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2024
	Plan of Correction
1 2 3 4	Licensee stated that the room has been a converted since license was issued and will provide proof to support it was a bedroom in 2002. Licensee will email LPA documents to support the the garage has been a bedroom by 4/19/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/05/2024 04:37 PM - It Cannot Be Edited

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: GROZOV FAMILY CHILD CARE	FACILITY NUMBER: 197409052
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in that Licensees Mandated Reporter Certificate was not readily available upon request which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2024
	Plan of Correction
1 2 3 4	Licensee stated they will complete Mandated Reporter Training and provided a copy of the certification by email to LPA by POC due date 4/19/2024.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in licensee did not have immunization records readily available upon request which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/12/2024
	Plan of Correction
1 2 3 4	Licensee stated they will provide proof of immunization and email a copy to LPA by POC due date 4/19/2024.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/05/2024 04:37 PM - It Cannot Be Edited

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: GROZOV FAMILY CHILD CARE	FACILITY NUMBER: 197409052
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.2(a)

Reporting Requirements

(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in that Licensee did not notify the department of changes to the facility as the garage (from the facility map dated 7/3/2002) was converted to a sleeping room for children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2024
	Plan of Correction
1 2 3 4	Licensee stated they will review the child care videos on CDSS.ca.gov and review regulation above. Licensee will email LPA upon completion by POC due date 4/19/2024.

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, children's record review, the licensee did not comply with the section cited above in that 4 out 4 childrens files did not contain immunization records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2024
	Plan of Correction
1 2 3 4	Licensee stated they will obtain the immunization records for alll enrolled children in care and provide LPA a copy by email by the POC due date 4/19/2024.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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: GROZOV FAMILY CHILD CARE	FACILITY NUMBER: 197409052
	VISIT DATE: 04/05/2024

NARRATIVE

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Per Licensee, there are no firearms or ammunition on the premises.

All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

The fireplace located in the living room is made inaccessible by use of a metal screen. Per Licensee, fireplace is not used, and LPA observed decorative items behind screen.

There is a working fire extinguisher, combination smoke and carbon monoxide detector (dining room) and adequate heating and ventilation for safety and comfort.

An emergency fire/disaster drill has been completed and documented within the last 6 months on 1/10/2023.

There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee.

LPA discussed the safe sleep regulations with licensee 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.

Licensee was reminded that children in care are to be supervised at all times and made aware that 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.

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SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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: GROZOV FAMILY CHILD CARE	FACILITY NUMBER: 197409052
	VISIT DATE: 04/05/2024

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Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were incomplete. LPA observed 4 of 4 children files missing immunization records, 1 of 4 children files missing LIC700 Identification and Emergency information, 3 of 4 files missing LIC995 Notification of Parents Rights and 3 of 4 children files missing LIC627 Consent for Emergency Medical Treatment.

LPA observed LIC 9040 Child Care Facility Roster to be complete.

LPA reviewed personnel records. LPA observed personnel files with First Aid CPR certificates from a vendor that was from American Red Cross, American Heart Association or EMSA vendor. LPAs observed personnel records to have no Mandated Reporter Training AB1207 certificate available upon request. LPA observed personnel files not to have influenza vaccination, immunization records, or TB test available upon request.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC809 (FAS) - (06/04)

Page: 7 of 8

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: GROZOV FAMILY CHILD CARE	FACILITY NUMBER: 197409052
	VISIT DATE: 04/05/2024

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During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

The following deficiencies listed on the attached deficiencies pages are being cited in accordance with California Code of Regulations Title 22. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent.) During this visit, the Licensee was provided with a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports Form and LIC 995A Notification of Parents’ Rights.

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

Exit interview conducted and report and appeal rights were reviewed with the Edith Grozov, Licensee.

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SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC809 (FAS) - (06/04)

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