197494174-6-18-2019-30-CC-MJVZ-BD9UNY-20190618154440

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494174
Report Date: 06/18/2019
Date Signed: 06/18/2019 03:44:56 PM

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:	SPIRIDONOVA FAMILY CHILD CARE		FACILITY NUMBER:	197494174
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	06/18/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:41 PM
MET WITH:	Nellia Spiridonova, Applicant & Elvira Ruzov, Applicant's Daughter		TIME COMPLETED:	04:04 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	Licensing Program Analyst (LPA) Martha Vasquez conducted an announced pre-licensing inspection to the facility to ensure the health and safety standards as required by regulations, statues, and requirements governing California family child care homes. Present at time of inspection was Nellia Spiridonova, Applicant and Elvira Ruzov, Applicant's adult daughter, and daughter's toddler son. Applicant's daughter provided Russian translation throughout the entire inspection. LPA reviewed the facility sketch (indoor and outdoor) and it was observed to match the physical plant of the home. LPA was guided on a tour of the home inside and outside at 01:41 PM. Per the applicant, the residents at the facility is the applicant and her adult daughter who is currently away in college. According to the applicant, she plans to operate her daycare Monday thru Friday from 7:30 AM - 6:00 PM. The home is a one story single-family house at includes: 1 front yard - off limits. 3 bedrooms located near the main hallway area - first bedroom on the left hand side will be on limits. The other bedrooms further down the hallway is off limits. 2 bathrooms - the "Jack and Jill" bathroom connecting the on limit bedroom and the off limit master bedroom is on limits. The bathroom located in the hallway area is off limits. 1 kitchen - off limits. 1 attached garage area near the kitchen area that includes a laundry area - off limits. 1 living room / dinning room combo area - on limits. According to the applicant, this is where primary care will be provided. Please note, there is also a chimney and two fireplaces located in between both areas. 1 backyard - on limits. 2 side yards - off limits. . (Continued)

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Martha J Vasquez	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019

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 4

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: SPIRIDONOVA FAMILY CHILD CARE	FACILITY NUMBER: 197494174
	VISIT DATE: 06/18/2019

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
26
27
28
29
30
31
32

.Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com.

Applicant was reminded of their responsibility to report suspected child abuse. Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Be Maintained At The Facility - Family Child Care Home.

Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

Applicant was made aware that once licensed, it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Applicant was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Applicant was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations.

Licensure will be granted upon final review by LPA Vasquez. Copy of this report was provided to the applicant at time of inspection. Exit interview was conducted.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Martha J Vasquez	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: SPIRIDONOVA FAMILY CHILD CARE	FACILITY NUMBER: 197494174
	VISIT DATE: 06/18/2019

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
26
27
28
29
30
31
32

Applicant agrees to operate the family child care home in a way to reflect a home-like environment and agrees to the following per Children’s Personal Rights Title 22 Regulation(s): 102423 (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (1) To be treated with dignity in his/her personal relationship with staff and other persons. (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. (3) To have parents or guardians informed by the licensee of the provisions of the law regarding complaints and the procedures for registering complaints confidentially, including, but not limited to the address and telephone number of the licensing agency's complaint unit. (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. Applicant was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Applicant was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Applicant was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

The applicant was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. The applicant was made aware that a licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

(Continued)

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Martha J Vasquez	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: SPIRIDONOVA FAMILY CHILD CARE	FACILITY NUMBER: 197494174
	VISIT DATE: 06/18/2019

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
26
27
28
29
30
31
32

The following was observed by LPA during the inspection:
1. Adults living in the home have submitted fingerprints and child abuse index check forms to Department of Justice.
2. Home is neat and clean.
3. Heaters are screened to prevent access by children.
4. Home is equipped with a fire extinguisher.
5. Home has a working smoke alarms and a carbon monoxide detector.
6. Home has a working telephone.
7. All poisons are locked.
8. Hazardous materials are kept out of the reach of children (inaccessible):
Kitchen: all sharp utensils and cutlery, cleaning supplies, medicines, drawers and cabinets with liquor, plastic bags, and sharp things or small things children can swallow.
Bathroom: shampoo, mouthwash, toothpaste, medicines, and perfumes/lotions/cosmetics.
9. According to the applicant, there are no weapons or firearms at the home. None were observed by LPA.
10. Outdoor play area is fenced in.
11. Toys and playthings are safe, clean, and appropriate for the age of the children.
12. Applicant agrees that no babywalkers, bouncers, jumpers, and similar items will not be used for children in care and are kept inaccessible.
13. A copy of the control of property was observed during inspection.
14. LPA observed preventative health and safety training certificate(s). LPA observe 1^st Aid and CPR card(s) to expire on 11/2020.
15. The home is equipped with a first aid kit.

At this time, the facility does not provide Incidental Medical Services - IMS

(Continued)

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Martha J Vasquez	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019

LIC809 (FAS) - (06/04)

Page: 4 of 4