<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493499
Report Date: 03/27/2023
Date Signed: 03/27/2023 12:07:55 PM


Document Has Been Signed on 03/27/2023 12:07 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:KUBI FAMILY CHILD CAREFACILITY NUMBER:
197493499
ADMINISTRATOR:KUBI, LIRANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 625-4840
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:14CENSUS: 9DATE:
03/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Liran Kubi- LicenseeTIME COMPLETED:
12:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/27/2023, Licensing Program Analyst (LPA) Suzette Ornelas made an unannounced visit for the purpose of conducting an initial investigation for Conntrol # 58-CC-20230323153125. LPA met with licensee, Liran Kubi and her husband Zack Kubi. LPA toured the facility and observed 9 children in care supervised by 3 adults.

Upon touring the facility LPA observed a pool in the backyard area with a fence that is 53 inches high with 2 self-latching gates that open away from the pool or body of water. Additionally, the children's outdoor play area is not directly next to the pool area and there is nothing placed next to the pool fence that would allow children to be able to climb over into the pool area. LPA observed a second child safety gate approximately 2 feet high that separates the children's outdoor play area from the pool area.

LPA explained to licensee that per regulation, Operation of a Family Child Care Home 102417(g)(5)(A). Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view.

Due to not having a current facility sketch, LPA obtained updated facility sketch of the premises.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: Type B Operation of a Family Child Care Home 102417(g)(5)(A) (see next page, 809 D)

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: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
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 2


Document Has Been Signed on 03/27/2023 12:07 PM - It Cannot Be Edited

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: KUBI FAMILY CHILD CARE
FACILITY NUMBER: 197493499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2023
Section Cited

1
2
3
4
5
6
7

Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground)... (A)Fences shall be at least five feet high... This requirement is not met as evidenced by:
1
2
3
4
5
6
7


Licencee agreed to have pool gate to meet 5 feet high regulation requirement on or before 06/27/2023.
8
9
10
11
12
13
14

Based on observation, interview with licensee, and record review of previous visit reports, the licensee did not comply with the section cited above in pool was observed with a 53 inch gate which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2