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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494347
Report Date: 04/15/2021
Date Signed: 04/15/2021 12:31:40 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:BRELLA PLAYA VISTA - INFANTFACILITY NUMBER:
197494347
ADMINISTRATOR:KENNER RAKOVFACILITY TYPE:
830
ADDRESS:12746 JEFFERSON BL, #3-3100TELEPHONE:
(213) 300-5962
CITY:PLAYA VISTASTATE: CAZIP CODE:
90064
CAPACITY:10CENSUS: DATE:
04/15/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Director RakovTIME COMPLETED:
01:00 PM
NARRATIVE
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On March 25th, 2021, Licensing Program Analyst Lisa Rios conducted an unannounced Case
Management - Deficiencies tele-inspection (due to Covid-19). LPA met with the Director Kenner Rakov.

Over the course of the last two weeks the provider has been emailing LPA Rios employees who have been recently livescanned and new associations to the facility. The facility roster for employees show that all of these employees started work prior to criminal record clearance and prior to association.

Facility was found to be out of compliance and two Type A deficiencies have been cited.

See LIC809D for citations associated to lack of criminal record clearances.


The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.

An exit interview was conducted with Kenner Rakov. A copy of this report and appeal rights are being emailed to licensee and LPA asked for signature and to scan back.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021
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 2
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: BRELLA PLAYA VISTA - INFANT
FACILITY NUMBER: 197494347
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/15/2021
Section Cited

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101216 (i)(1) Personnel Requirements: Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall:(1)Obtain a California clearance or a criminal record exemption as required by law or ....
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...Department Regulations. This requirement is not met as evidenced by...the Administrator submitted to the ES RO the criminal records clearances for 5 staff that were hired prior to applying for criminal record clearance.
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Type A
04/15/2021
Section Cited

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101216(i)(2) Personnel Requirements Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall:(2) Request a transfer of a criminal record clearance as specified in ...
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 Section 101170(f). This requirement is not met as evidence by: the Administrator submitted to the ES RO the criminal records clearance transfer requests for 5 staff that were hired prior to transferring criminal record clearances.
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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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2021
LIC809 (FAS) - (06/04)
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