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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493499
Report Date: 06/08/2023
Date Signed: 06/08/2023 12:49:54 PM


Document Has Been Signed on 06/08/2023 12:49 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: 12DATE:
06/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Liensee- KUBI, LIRANTIME COMPLETED:
01:50 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 06/08/2023, Licensing Program Analyst (LPA) Suzette Ornelas made an unannounced visit for the purpose of conducting a case management inspection. LPA met with licensee, Liran Kubi and her husband Zack Kubi. LPA toured the facility and observed 12 children in care supervised by 3 adults.

On 03/27/2023, LPA observed a pool in the backyard area with a fence that was not meetings regulation requirements of being at least 5 feet high. The children's outdoor play area was not directly next to the pool area and there was 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 separating the children's outdoor play area from the pool area.
On 03/27/2023, the following deficiency was cited: Type B Operation of a Family Child Care Home 102417(g)(5)(A)

During todays visit, LPA inspected the pool gate and observed it to be fenced per regulation making it inaccessible. The pool gate is at least 5 feet high, self-latching, self-closing and opens away from the swimming pool.

Deficiency was cleared today 06/08/2023 and a copy of the POC letter was provided to licensee.

An exit interview was conducted, and a copy of this report, along with the Notice of Site Visit were
provided to Licensee, Liran Kubi.
SUPERVISOR'S NAME: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023
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 1