197494651-10-2-2020-30-CC-MGAA-BTZTKW-20201002144834

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494651
Report Date: 10/02/2020
Date Signed: 10/02/2020 02:48:48 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:	PINCHEVSKIY FAMILY CHILD CARE		FACILITY NUMBER:	197494651
ADMINISTRATOR:	PINCHEVSKIY, NATALIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 730-7320
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91403
CAPACITY:	14	CENSUS: 10	DATE:	10/02/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:31 AM
MET WITH:	Applicant Natalia Pinchevskiy		TIME COMPLETED:	02:05 PM

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On 10.02.20, Licensing Program Analyst (LPA) Miguel Garcia and Licensing Program Manager (LPM) Victor Bautista conducted this announced pre- Licensing tele-inspection at 15433 Huston Street, Sherman Oaks, CA 91403. The applicant Natali Pinchevskiy has applied for a licensee of a total capacity of 14 children: ages 1.5 to 12 years old. On 08.11.20, the fire clearance was approved by Inspector Miller of the Los Angeles City Fire Department. It is noted that this location is presently licensed by Community Care Licensing Division. The facility is licensed as Tytutyunnik Family Child Care, license # 197493803. The purpose of this pre- Licensing is to ensure that the facility physical plan complies with the California Code of Regulation Title 22 and California Health & Safety Codes. During the tele-visit, LPA Garcia checked the interior and exterior of the facility. The home is a single family, single story home with 4 bedrooms, 1 living room, 1 family room, 1 living room, 1 dinning room, kitchen, office room/laundry room, and backyard where the playground is located. The bedroom located by the main entrance to the left is off-limits and the office room/laundry room is also off-limits. Children utilize the back yard. There is no swimming pool or bodies of water on the premises. LPA Garcia observed that the license has a First aid kit. The applicant submitted an Incidental Medical Services (IMS) plan.

LPA Garcia discussed with the applicant the following:

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

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SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (414) 301-3008
LICENSING EVALUATOR NAME: Miguel Garcia	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2020

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: PINCHEVSKIY FAMILY CHILD CARE	FACILITY NUMBER: 197494651
	VISIT DATE: 10/02/2020

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Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. Licensee's and assistant's immunization records are up to date.

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

The following corrections and advisory were discussed with the applicant.

Corrections:

· On the side of the house by the driveway, there is a double door fence which must be closed during the hours of operations.

· Applicant shall provide evidence that she resides in the home, such as an utility bill.

Advisory:

· All adults shall submit a criminal record clearance review, TB test, verification of flue vaccination or pertaining waiver.

· Child safety gates must be on at all times during hours of operations.

· The door of the office room/laundry room must be locked at all times during hours of operations

An exit interview was conducted with the applicant Natalia Pinchevskiy via telephone and advised that a copy of this report would be sent via email. The Applicant agrees to submit the above requirements. A copy of this report was sent to the applicant via email. The Applicant agrees to reply to the email stating the report was received and read as verification in lieu of a signature as required by tele-inspection protocols.

Licensure of this application will be considered by Community Care Licensing Division (CCLD) after it receives the above stated documents and have been reviewed by CCLD management.

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (414) 301-3008
LICENSING EVALUATOR NAME: Miguel Garcia	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2020

LIC809 (FAS) - (06/04)

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