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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419103
Report Date: 07/13/2022
Date Signed: 08/05/2022 02:10:28 PM


Document Has Been Signed on 08/05/2022 02:10 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:FEDENKO & FAYTELSONFACILITY NUMBER:
197419103
ADMINISTRATOR:FAYTELSON, JULIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 600-8484
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:14CENSUS: 11DATE:
07/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:49 AM
MET WITH:Olga FedenkoTIME COMPLETED:
01:30 PM
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On 7/13/2022 Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection and was met by Olga Fedenko.

Days and hours of operation are 7:30 a.m. to 6:30 p.m., Monday through Friday. Currently applicant cares for children ages 2 years old to 5 years old. Facility does not take in children under the age of 12 months old and facility is not available for overnight care.

LPA toured the home inside and outside and a census was taken; 11 children were present with licensee and one other adult. Licensee confirmed that the living room/dining room area are designated for children to use. Applicant confirmed children nap in Master bedroom. The children eat in the dining room area designated as day care space. The bathroom that children use is next to bedroom 1. LPA inspected and observed the bathroom space. Bedroom 2 is also designated as day care space.

The following areas are currently OFF LIMITS: the kitchen, bedroom 1 and master bathroom. Bedroom 1 has a door that leads to the attached garage. All areas off limits were observed to have a child proof plastic doorknob covers. The kitchen was observed to have a safety gate at both entry ways, making the area inaccessible to the children in care.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible; locked in the kitchen sink cabinet.

There are no fireplaces or open face heaters in the home. There is a working fire extinguisher located in the kitchen area. A smoke detector and carbon monoxide detector
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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 6


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: FEDENKO & FAYTELSON
FACILITY NUMBER: 197419103
VISIT DATE: 07/13/2022
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were observed in the living room/dinning area. There is adequate heating and ventilation for safety and comfort. Facility does not have any stairs. LPA observed three small steps that lead to the back yard that have been fenced.

Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (310) 900-9610 or (818) 600-8484.
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. Licensee’s Mandated Reporter Training was not available for review. Licensee agrees to complete online training and submit proof of completion by 7/27/2022. Licensee’s pediatric CPR/First Aid was completed on 5/28/2022. A review of immunization records was not available and licensee was given a technical violation and will submit proof to LPA vial email by 7/27/2022- immunization records for MMR and Tdapt and influenza/flu.
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.

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/inspection-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.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: FEDENKO & FAYTELSON
FACILITY NUMBER: 197419103
VISIT DATE: 07/13/2022
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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.

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 Olga Fedenko.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC809 (FAS) - (06/04)
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