197418997-10-10-2022-58-CC-DADS-CK3V24-20221010160231

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197418997
Report Date: 10/10/2022
Date Signed: 10/10/2022 04:02:46 PM

Document Has Been Signed on 10/10/2022 04:02 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:	AZHEUSKAYA FAMILY CHILD CARE		FACILITY NUMBER:	197418997
ADMINISTRATOR:	AZHEUSKAYA, AKSANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 667-3490
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	14	CENSUS: 10	DATE:	10/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Licensee, Aksana Azheuskaya		TIME COMPLETED:	04:15 PM

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On 10/10/2022 at 2:15 PM Licensing Program Analyst (LPA) Dalicia Adkins, conducted an unannounced Annual Required Inspection and was met by Licensee, Aksana Azheuskaya. Days and hours of operation are Monday- Friday 7:30am – 6:00pm

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that the kitchen, bathroom and living room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of locked doors. There is no swimming pool or other bodies of water on the premises 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 dance room/activity room is made inaccessible by a screen and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 667-3490.

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

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Dalicia Adkins	TELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

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: AZHEUSKAYA FAMILY CHILD CARE	FACILITY NUMBER: 197418997
	VISIT DATE: 10/10/2022

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Licensee ensures that children in care are supervised at all times and is aware 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. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. LPA Adkins provided licensee with technical assistance. Licensee registered for mandated reporting on Community Care Licensing online course and will send LPA Adkins a certificate of completion by 10/11/2022. Licensee’s pediatric CPR/First Aid expires on July 2024. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

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) not 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: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Dalicia Adkins	TELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

LIC809 (FAS) - (06/04)

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