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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493534
Report Date: 12/10/2019
Date Signed: 12/11/2019 09:38:17 AM

COMPREHENSIVE INSPECTION
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:TAVKHELIDZE FAMILY CHILD CAREFACILITY NUMBER:
197493534
ADMINISTRATOR:TAVKHELIDZE, AMRINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 660-3200
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:14CENSUS: 4DATE:
12/10/2019
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Amrin TavkhelidzeTIME COMPLETED:
09:50 AM
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On 12/11/2019 at 8:45 AM Licensing Program Analysts (LPA) Stella Gutierrez arrived at the licensed facility for the purpose of conducting Case Management/ Plan of Correction (POC) inspection to ensure Licensee is in compliance of Title 22 regulations. LPA met with Licensee, Amrin Tavkhelidze who guided the LPA on a tour of the facility. Upon arrival LPA observed 4 children (1 infant and 3 pre-schoolers) one staff. Licensee is operating within the capacity and ratio of the license.

LPA, Gutierrez toured the facility inside and out. The following was observed during today’s visit.
All areas were clean and free from any potential or immediate hazards that can pose a danger to children in care. Licensee was reminded by LPA, Gutierrez to ensure that facility stays in compliance per title 22 and Health and Safety codes standards. LPA advised Licensee how to access the Community Care Licensing for forms, regulations and Health and Safety Codes that are required to be met 100% of the time the facility's operational hours.

Items received via email and observed today are as follows:

1. LPA, Gutierrez received pictures on 12/6/2019 of the Hot tub removed from play yard. LPA observed that hot tub was removed completely from the facility and pictures taken of the play area.
2. LPA received Mandated reporter Certificates of completion for all staff including Licensee that are associated with the facility via email on 12/10/2019. Completion date 12/9/2019. Licensee was advised to renew every two years.
3. Parents signed LIC 9224 form copies received via email on 12/10/2019 and were observed during today's visit. Advised Licensee that each newly enrolled child for 1 year from initial Annual Visit made on 12/04/2019 has to sign the LIC #9224 and to be kept in the children's file.
4. Advisory Correction of serviced Fire Extinguisher received via email on 12/10/2019 and observed during
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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
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: TAVKHELIDZE FAMILY CHILD CARE
FACILITY NUMBER: 197493534
VISIT DATE: 12/10/2019
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today's visit. LPA advised Licensee that Fire Extinguisher annually.

LPA, Gutierrez observed the facility to be in compliance with title 22 regulations and Health and Safety codes. Plan of Corrections cleared today. No deficiencies were cited during this inspection.

An exit interview was conducted, and a copy of the report was given to licensee, Amrin Tavkhelidze.


SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
LIC809 (FAS) - (06/04)
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