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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416073
Report Date: 07/25/2022
Date Signed: 01/20/2023 03:19:48 PM


Document Has Been Signed on 01/20/2023 03:19 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:ASSERAF FAMILY CHILD CAREFACILITY NUMBER:
197416073
ADMINISTRATOR:ASSERAF, RIKKIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 744-5447
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:14CENSUS: 12DATE:
07/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:ASSERAF, RIKKI- LicenseeTIME COMPLETED:
11:00 AM
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On 07/25/2022 Licensing Program Analyst (LPA), Suzette Ornelas conducted an unannounced Annual Required Inspection and was met by Licensee, ASSERAF, RIKKI. Also present was Staff #1 (S1). Days and hours of operation are Monday through Friday 8a to 4:30p.

LPA toured the home inside and outside and a census was taken. LPA observed 12 children. Current facility sketch reviewed and Licensee confirmed that Rikki’s Day Care Room, which is equipped with restroom is on limits and accessible to children in care. All other rooms are off-limits and made inaccessible by use of locked doors and supervision. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The First Aid kit was observed and complete. Per LIS the facility annual fees are current. The facility roster was observed, and current. There are age appropriate toys and napping equipment on the premises. The required fire extinguisher (2A 10BC), carbon monoxide detector and smoke detector is in operable condition. Licensee has posted as required the License, and all other required postings in a visible location.

There are no firearms or ammunition on the premises. 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. The fireplace located in the living room is made inaccessible by a screen and will not be in use during day care hours. There are no stairs in this home.

There are currently 2 infants in care. LPA discussed Safe Sleep Regulations with licensee and provided a copy of the Infant Safe Sleep Regulation, a sample of an infant safe sleep log, a copy of the LIC 9227, and Frequently Asked Questions regarding Infant Safe Sleep. Licensee will immediately begin documentation of Infant Safe Sleep. Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022
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 3


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: ASSERAF FAMILY CHILD CARE
FACILITY NUMBER: 197416073
VISIT DATE: 07/25/2022
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Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the front yard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained. LPA reviewed 10 children's records and observed records were complete.

An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s pediatric CPR/First Aid expires on 2024. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, TB, pertussis and measles. Licensee and all other employees have completed the Mandated Reporter Training. 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) are currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022
LIC809 (FAS) - (06/04)
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