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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494174
Report Date: 08/14/2019
Date Signed: 08/14/2019 03:32:14 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 CAREFACILITY NUMBER:
197494174
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
08/14/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Nellia Spiridonva, Licensee and
Liudmyla, Assistant 		TIME COMPLETED:
03:52 PM
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Licensing Program Analyst (LPA) Martha Vasquez conducted a case management inspection to the aforementioned facility for the purpose of verifying the operation of a family child care home and to ensure the health and safety standards as required by regulations, statues, and requirements governing California family child care homes. Upon arrival to the facility, LPA met with Nellia Spiridonva, Licensee and Liudmyla, Assistant who are both fingerprinted cleared and associated to the facility. LPA toured the facility indoors and outdoors with the licensee at 1:26 PM. LPA observed three children in care napping in the on limit bedroom; none of whom were infants. According to the licensee the facility’s days and hours of operation are Monday - Friday, 8:00AM - 6:PM. Residents at the facility is herself and no one else. The following was observed during the tour inside and outside of the facility:

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 are 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 licensee, this is where primary care is provided.
  • 1 backyard - on limits.
  • 2 side yards - off limits.

(Continued)
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Martha J VasquezTELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
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: SPIRIDONOVA FAMILY CHILD CARE
FACILITY NUMBER: 197494174
VISIT DATE: 08/14/2019
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LPA conducted a children's records review as well as staff records review during this inspection. No violations were cited during the inspection. The facility is operating in substantial compliance during the inspection.

Exit interview was conducted and copy of this report was provided.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Martha J VasquezTELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
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