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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494174
Report Date: 06/18/2021
Date Signed: 06/18/2021 12:34:41 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:SPIRIDONOVA, NELLIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 441-3575
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY:14CENSUS: 11DATE:
06/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:17 AM
MET WITH:Ella Ruzov-daugterTIME COMPLETED:
12:41 PM
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 On 6/18/2021 Licensing Program Analyst, Jillinda Chandler conducted an unannounced 1 year required-Annual Random visit for Spiridonova FCCH. Upon arrival present in the home were two assistants and 11 daycare children, the licensee was unavailable and her daughter was called the home for translation purposes. The home was inspected inside and out according to the LIC 999 -facility sketch,for health and safety compliance per Title 22.
LPA observed the following:
Care and supervision were observed
The homes capacity was within the scope of the license
Appropriate size fire extinguisher carbon and smoke detector present & operable.
Detergents, and knives were inaccessible, Toxins were locked and inaccessible.
No guns or weapons present as stated by the Licensee, no weapons observed by LPA.
Cell phones are used as a form of communication.
License, facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights Poster and California Safety Seat Law are posted
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
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: 06/18/2021
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At least one person present had current infant pediatric CPR and First Aid Card that expires 9/27/22
No bodies of water on the premises
Children records available and in good order.
Toys, equipment and materials available and in good order
Out door activity area located in the rear of the home did not pose any hazardous conditions. Three hens were observed in a chicken coupe, no potential hazards were observed.

No citations were issued during todays inspection, an exit interview was conducted and a copy of this report was left at the home.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
LIC809 (FAS) - (06/04)
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