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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413719
Report Date: 11/08/2022
Date Signed: 11/08/2022 11:56:47 AM


Document Has Been Signed on 11/08/2022 11:56 AM - 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:GOGUNSKA & OSTAPCHUK FAMILY CHILD CAREFACILITY NUMBER:
197413719
ADMINISTRATOR:GOGUNSKA, OLENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 702-3796
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:14CENSUS: 9DATE:
11/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Olena Gogunska, LicenseeTIME COMPLETED:
12:15 PM
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On 11/8/2022, 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 Olena Gogunska, Licensee. LPA toured the inside and outside of the property. LPA observed the home to be clean, safe, orderly and well ventilated. There were 9 children present with 2 additional staff. The operating hours are Monday thru Friday 8:00am to 6:00pm. LPA confirmed telephone number:323 702 3796 is still correct.

LPA observed the home to have a Living Room, Dining Room, Kitchen, 2 bedrooms, and 2 bathrooms. The Licensee utilizes the living room, dining room and bedroom 1 areas 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 and eating. Bedroom 1 is used for napping. LPA observed cots that are used for napping. 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. The home has central air & heat.

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. LPA observed operable smoke detectors and carbon monoxide detectors throughout the home. The home is equipped with 1 (2-A:10-B:C) Fire Extinguisher and First Aid kit which includes thermometer and band aids.

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

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
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: GOGUNSKA & OSTAPCHUK FAMILY CHILD CARE
FACILITY NUMBER: 197413719
VISIT DATE: 11/08/2022
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Staff and children's files were reviewed during inspection. Both Licensees CPR card expires 07/3/2023. Mandated Reporter training and immunization records requirements were reviewed during inspection. LPA reviewed records related to earthquake drills and fire drills which were found to be current. All required Child Care Postings was observed on the Parent Board during inspection.

In accordance with California Code of Regulations, Title 22, Division 12, Chapter 3 of Family Child Care Homes, during today's visit, no deficiencies were observed.

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.

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.

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

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 Olena Gogunska.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC809 (FAS) - (06/04)
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