197419361-6-7-2022-30-CC-SGAN-CF6NE3-20220607102315

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419361
Report Date: 06/07/2022
Date Signed: 06/07/2022 10:31:06 AM

Document Has Been Signed on 06/07/2022 10:31 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	GLUKHOVA FAMILY CHILD CARE		FACILITY NUMBER:	197419361
ADMINISTRATOR:	GLUKHOVA, OKSANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 399-8222
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	14	CENSUS: 6	DATE:	06/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	07:43 AM
MET WITH:	Oksana Glukhova/Licensee		TIME COMPLETED:	10:25 AM

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On 06/07/2022 Licensing Program Analyst (LPA) Silva Garibyan, conducted an unannounced A Required Inspection and was met by Licensee, Oksana Glukhova. Also present was Staff #1 (S1). Days and hours of operation are Monday – Friday from 8:00 AM to 6:00 PM. Family members residing at facility are: 2 adults ( licensee and spouse) and 2 children ( 9 years old daughter and 4 year old son). Licensee was reminded that her children under 10 years of age, count in her capacity whenever they are present. Children enter the day care area through a side gate.

LPA toured the home inside and outside and a census was taken. There were 6 preschool age children present at the time of the visit. Current facility sketch was reviewed and Licensee confirmed that the Child Care Studio/Play Room and the bathroom in the laundry area are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of safety gate and locked kitchen door. There is a covered jaccuzi on the premises. The jaccuzi is fenced per regulation. The jaccuzi gate is self-latching, self-closing and opens away from the jaccuzi. No windows or doors have direct access to the jaccuzi area. 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 non-working fireplace (gas line has been disconnected) located in the child care room is made inaccessible by a screen and safety gate.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GLUKHOVA FAMILY CHILD CARE	FACILITY NUMBER: 197419361
	VISIT DATE: 06/07/2022

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There are two working fire extinguishers ( 3-A:40-B:C and 1-A:10 BC), smoke detectors, carbon monoxide detectors and adequate heating and ventilation for safety and comfort. There are no stairs in this home. The home has working telephone service and LPA confirmed the phone number is (818) 399-8222.

There is one infant ( 20 months old) enrolled in care. LPA discussed Safe Sleep Regulations with licensee. There is one play yard for the infant enrolled in care, and play yard is kept free from all loose articles and objects while infant is sleeping, and there are no objects hanging above or attached to the play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing.

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.

Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s Mandated Reporter Training was completed on 06/12/2020. Licensee’s pediatric CPR/First Aid expires on 05/09/2024. 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.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GLUKHOVA FAMILY CHILD CARE	FACILITY NUMBER: 197419361
	VISIT DATE: 06/07/2022

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Incidental Medical Services (IMS) are 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: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC809 (FAS) - (06/04)

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