197493596-6-12-2024-58-CC-SGAN-D66PBW-20240612111102

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493596
Report Date: 06/12/2024
Date Signed: 06/12/2024 11:11:12 AM

Document Has Been Signed on 06/12/2024 11:11 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	STOLYAROVA FAMILY CHILD CARE		FACILITY NUMBER:	197493596
ADMINISTRATOR/ DIRECTOR:	STOLYAROVA, ALINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 921-2540
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 5	CENSUS: 7	DATE:	06/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	07:25 AM
MET WITH:	Alina Stolyarova, Licensee		TIME VISIT/ INSPECTION COMPLETED:	11:20 AM

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 06/12/2024 Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit. The purpose of this visit is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes. The licensee was present with seven children. Hours of operation for the facility will be 8:00 AM- 6:00 PM Monday- Friday and will be closed all major holidays. LPA toured the home inside and outside and a census was taken. There were seven children present (including three infants and Licensee’s two children under 10 years of age) at the time of the visit. Current facility sketch was reviewed and Licensee confirmed that the family room/play room, the dining room, and the bedroom (1) adjacent to the family room are used for providing care and are accessible to children. All other rooms (living room, two bedrooms (2) and (3), Bathroom(2) in the hall way, office, kitchen, attached garage) are off-limits and made inaccessible by use of locked door. 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. The screened fireplaces are located in the family room and in the living room. The fireplaces are inoperable. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Page 1

Betty Bell	TELEPHONE:
Silva Garibyan	TELEPHONE:
	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: STOLYAROVA FAMILY CHILD CARE	FACILITY NUMBER: 197493596
	VISIT DATE: 06/12/2024

NARRATIVE

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There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service. LPA observed the fire drill log. The fire drills are done every month.
LPA toured the back yard and the side yard and found them to be fully fenced.
LPA observed in the family room the Parent Board with all necessary postings required ( Facility License (LIC 203), Emergency Disaster Plan (LIC610A), Notification of Parents' Rights Poster (PUB 394), If You see Something Say Something poster, Car Seat Safety poster, Effects of Lead Exposure poster). Child Care Facility Roster (LIC9040) was on file.
A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card, LIC9227/ and sleep log.
Family room and Dining room were observed to have age appropriate toys. Seven children size tables and 10 chairs were observed in the dining room. Eight beds, three cribs, and a play yard were observed in the bedroom (1).
LPA observed licensee test the carbon monoxide and smoke detector in the hall way. The Fire Extinguisher (3-A:40-B:C) is mounted on the wall in the kitchen. All electrical outlets were observed to be covered. Smoke/Carbon Monoxide detectors are located in the family rooms.
The bathroom that children use is located in the bedroom (1). LPA observed one toilet, two sinks, and one shower in the bathroom. LPA observed a shower free of shampoos and soaps. The bathroom was observed to be free of hazards.
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SUPERVISOR'S NAME: Betty Bell	TELEPHONE:
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: STOLYAROVA FAMILY CHILD CARE	FACILITY NUMBER: 197493596
	VISIT DATE: 06/12/2024

NARRATIVE

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The kitchen was observed and inspected. All lower cabinets were inspected and observed to have safety latches, making the contents inaccessible to the children in care. Under the sink cabinet was observed to have cleaning supplies and LPA observed a safety latch, making the content inaccessible. All knives and sharp objects are stored in a drawer that was observed to have a safety latch making the items inaccessible. Licensee provides meals and snacks. LPA discuss food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date. The licensee has current pediatric CPR/First Aid training completed in December of 2023. Licensee and assistant did not have proof of completion of Mandated Reporter AB1207 training. Licensee does not have proof of immunization against influenza, pertussis, and measles to review for the assistant.
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. Page 3

SUPERVISOR'S NAME: Betty Bell	TELEPHONE:
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: STOLYAROVA FAMILY CHILD CARE	FACILITY NUMBER: 197493596
	VISIT DATE: 06/12/2024

NARRATIVE

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There are three infants enrolled at this time. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
During the exit interview, the licensee Alina Stolyarova, confirmed that there are no Registered Sex Offenders living in the facility.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Alina Stolyarova.
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SUPERVISOR'S NAME: Betty Bell	TELEPHONE:
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/12/2024 11:11 AM - It Cannot Be Edited

Created By: Silva Garibyan On 06/12/2024 at 10:43 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: STOLYAROVA FAMILY CHILD CARE	FACILITY NUMBER: 197493596
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above Licensee and Assistant did not have proof of completing the Mandated Reporter AB1207 training which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/19/2024
	Plan of Correction
1 2 3 4	Per Licensee, proof of correction will be sent to LPA via email by 06/19/2024.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above Licensee does not have proof of immuniations against influenza, pertussis, and measles for Assistnat to review,which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/19/2024
	Plan of Correction
1 2 3 4	Per Licensee, proof of correction will be sent to LPA via email by 06/19/2024.

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:

Betty Bell

TELEPHONE:

LICENSING EVALUATOR NAME:

Silva Garibyan

TELEPHONE:

LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC809 (FAS) - (06/04)

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