197494501-7-3-2024-58-CC-SGAN-D6TPEB-20240703111451

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494501
Report Date: 07/03/2024
Date Signed: 07/03/2024 11:19:09 AM

Document Has Been Signed on 07/03/2024 11:19 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:	GOZEN FAMILY CHILD CARE		FACILITY NUMBER:	197494501
ADMINISTRATOR:	NATALIE GOZEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 358-5980
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	14	CENSUS: 6	DATE:	07/03/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Natalie Gozen, Licensee		TIME COMPLETED:	11:10 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	Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit . LPA met with the licensee and toured the home inside and outside at 8:00AM on 07/03/2024. Licensee was present with six preschool age children and two assistants. Days and hours of operation are M-F, 8:00 AM – 6:00 PM. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the living room, dining room, and the step-down bathroom are used for providing care and are accessible to children. Entire second floor (including three bedrooms, two bathrooms), the kitchen, and the attached garage are off limits to the children in care. Safety gate is installed by the stairs to make the second floor inaccessible. Safety gate is installed to make the kitchen inaccessible. The children have access to the bathroom ( 4 steps down) located on the first floor. Applicant was reminded that children must be escorted when using the stairs. There is a pool in the back yard. LPA toured the backyard area to ensure that the pool fencing meets the Title 22 requirements. LPA observed the pool fencing to be 5 feet high, have a self- latching gate that swings away from the pool and has a self- latching device that is located no more than 6 inches from the top of the fence. The mesh fence encloses the pool on one side. The back and sides are enclosed by the property walls. The mesh fencing is sturdy and capable of withstanding the impact of children's toys including bicycles. There are no other bodies of water on the premises. Page 1

SUPERVISOR'S NAME: Betty Bell	TELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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: GOZEN FAMILY CHILD CARE	FACILITY NUMBER: 197494501
	VISIT DATE: 07/03/2024

NARRATIVE

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Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. Licensee reports she has no firearms or weapons in the home. LPA also observed Licensee's current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 12/2025). Licensee’s Mandated Reporter Training was completed on 08/10/2023. The LPA toured all areas used by children during this inspection. The bathroom utilized by children and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care. The fireplace located in the step-down family room is made inaccessible by a screen and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 358-5980. The outdoor play area/back yard was inspected. The back yard is fully fenced. Children's outdoor play equipment and toys are age appropriate and in good repair. The Fire Extinguisher (2A-10-BC) is mounted on the wall in the dining room. The First Aid kit was observed ( in the hallway closet), and complete. LPA observed the fire drill log. The fire drills are done every two months.
Licensee provides meals and snacks. LPA discussed food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date. Licensees stated that a cell phone with active service in the home will be the main contact number while children are in care.
LPA observed in the dining room 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). Child Care Facility Roster (LIC9040) was on file. Page 2

SUPERVISOR'S NAME: Betty Bell	TELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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: GOZEN FAMILY CHILD CARE	FACILITY NUMBER: 197494501
	VISIT DATE: 07/03/2024

NARRATIVE

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A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

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.
No infants are enrolled at this time. LPA discussed the safe sleep regulations with licensees 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.

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SUPERVISOR'S NAME: Betty Bell	TELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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: GOZEN FAMILY CHILD CARE	FACILITY NUMBER: 197494501
	VISIT DATE: 07/03/2024

NARRATIVE

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LPA also informed licensee 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/.

Licensees were 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 Natalie Gozen 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 Natalie Gozen.

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SUPERVISOR'S NAME: Betty Bell	TELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC809 (FAS) - (06/04)

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