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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411350
Report Date: 04/09/2024
Date Signed: 04/09/2024 06:01:16 PM


Document Has Been Signed on 04/09/2024 06:01 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:PASTUKHOV FAMILY CHILD CAREFACILITY NUMBER:
197411350
ADMINISTRATOR:PASTUKHOV, VIKTORFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 974-3143
CITY:WEST HOLLYWOODSTATE: CAZIP CODE:
90046
CAPACITY:14CENSUS: 7DATE:
04/09/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:Viktor Pastukhov, LicenseeTIME COMPLETED:
06:30 PM
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On 04/09/2024 at 4:15 PM, Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required – 3 Year inspection to the above facility. Upon arrival, LPA disclosed the purpose of the inspection and initially met with Licensee's Assistant (S1) who guided the LPA on a tour of the facility. Licensee arrived after tour. Adults in the home were discussed and all have criminal record clearance. Also present was second assistant (S2). There were seven day care children present during today’s inspection. S1 states that there are currently ten children enrolled. The children's roster was reviewed and is current. LPA discussed required postings at time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 01/22/2024.

This is a single-story home which consists of two bedrooms and one bathroom, Kitchen, Living Room, and Day Care Activity Space. Areas used by the children include the Living Room (located upon entry of the home), Day Care Activity Space (located next to Living Room), Kitchen (located next to Day Care Activity Space), Bathroom (located down hallway to the rear of the home), and Bedroom 1 (located next to Bathroom). Per Licensee, areas off limits to children and parents include Bedroom 2. LPA observed that there is a door that remains locked during operating hours.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone maintained in the home. At 4:15 PM, LPA observed Living Room to have couches, desk, table, and child size beds used for sleeping. At 4:17 PM, LPAs observed Day Care Activity Space to have a variety of age appropriate toys, free of loose and sharp parts such as a plush toys, bristle blocks, and mobile toys. LPA observed wall heater that is barricaded making it off limits. At 4:20 PM, LPA observed Kitchen to have child size table and chairs used for eating. LPA observed children eating in Kitchen upon arrival and food is provided by Licensee. LPA observed operable child safety locks on low cabinets making items in cabinets off limits at time of inspection. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. LPA observed these items in low cabinets with child safety locks
Report Continues - Page 1 of 4
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7


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: PASTUKHOV FAMILY CHILD CARE
FACILITY NUMBER: 197411350
VISIT DATE: 04/09/2024
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and high cabinets making it off limits at time of inspection. The Licensee states that there are no poisons used to kill vermin/bugs in the home. The Licensee does understand that poison must be locked with a key or combination lock. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the age, size, and abilities children in care. At 4:23 PM, LPA observed Bathroom to have adequate supplies, operable equipment, and to have general area safety and sanitation. At 4:25 PM, LPA observed Bedroom 1, that infants will use for napping, to have four pack-n-plays that are placed as to not inhibit entrances/exits and walkways. LPA observed pack-n-plays to have fitted sheets, free of loose items, and no items hanging above them at time of inspection.

Per Licensee, the children will have access to backyard for outdoor play which LPA observed is accessible through back door in Bedroom 1. At 4:30 PM, LPA observed backyard has adequate perimeter fencing through-out the yard and soft cushioning material through out floor that is well maintained. LPA observed a variety of age appropriate toys free of loose and sharp parts available for the children in the backyard such as plastic play houses, plastic climbing structure, and all trees, shrubs, and plants are maintained at time of inspection.

LPA did not observe any pets at time of inspection and Licensee confirms there are no pets. Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises or firearms/weapons at time of inspection.

At 4:40 PM, LPA observed the valve on the required 2A-10BC fire extinguisher indicates fully charged with proof of purchase date 10/24/2023. LPA tested smoke and carbon monoxide detectors and observed to be in operable condition. LPA observed First Aid supplies stored in high cabinet in Kitchen. Per Licensee, isolation area for sick children is flexible depending on which area of home is available and not being used by the children. There is at least one individual with current Pediatric First Aid and CPR valid until 02/2026. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee and staff has not taken the Mandated Reporter Training at time of inspection.

At 5:20 PM, LPA reviewed seven of seven children's records and observed all required forms in children's files including LIC 9227 for Child #1.
Report Continues - Page 2 of 4
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: PASTUKHOV FAMILY CHILD CARE
FACILITY NUMBER: 197411350
VISIT DATE: 04/09/2024
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The following were discussed:
Incidental Medical Services (IMS) policy 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/childqanda.htm

Licensee (or facility representative) 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.



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 License 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.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/
 Report Continues - Page 3 of 4

SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: PASTUKHOV FAMILY CHILD CARE
FACILITY NUMBER: 197411350
VISIT DATE: 04/09/2024
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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.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or facility representative] 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. Megan’s Law - Family Child Care Homes

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited only technical violations today, 04/09/2024.

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

Exit interview was conducted and report was reviewed with the Licensee, Viktor Pastukhov.


Report Ends - Page 4 of 4
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC809 (FAS) - (06/04)
Page: 4 of 7