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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495090
Report Date: 05/19/2022
Date Signed: 05/19/2022 11:35:49 AM


Document Has Been Signed on 05/19/2022 11:35 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:KIRSCHENSTEIN FAMILY CHILD CAREFACILITY NUMBER:
197495090
ADMINISTRATOR:MARIA KIRSCHENSTEINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 383-7988
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY:14CENSUS: 0DATE:
05/19/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maria Kirschenstein, LicenseeTIME COMPLETED:
11:45 AM
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On 05/19/2022 at 10:30 AM, Licensing Program Analyst (LPA) Sabrina Martinez arrived at 1044 Yale St., Santa Monica, CA 90403, for the purpose of conducting an announced prelicensing inspection. LPA met with Maria Kirschenstein, Applicant, and discussed the purpose of the visit. Present at the time of the inspection was applicant. LPA verified that all adults present in the home have obtained criminal record clearances and are associated to the facility. LPA reviewed the facility sketch (indoor and outdoor) and it was observed to match the physical plant of the home. Children in the family child care home will enter the facility through the side gate of the home. This is a 4 bedroom, 2-bathroom home with living room, dining room, kitchen, front yard and backyard. The following areas are designated as follows:
**Bedroom #1 and Bathroom #1- Off limits to day care children. Applicant stated this bedroom is locked during day care hours.
**Bedrooms #2, #3, and #4, living room, and dining room. - Accessible to day care children. LPA observed these rooms to have age appropriate furniture, games, learning materials and activities for children in care. Furniture was observed with no loose or sharp parts, clean and in good repair.
**Bathroom #2 – Accessible to day care children. Children in the family child care home will utilize this bathroom. LPA inspected the bathroom and did not observe any medications, toxins or cleaning compounds that would pose a risk to children in care.
**Front yard- Off limits to day care children.
**Backyard---This is where outdoor play will be conducted. Backyard was observed to be clean and free from miscellaneous debris and trash.
The carbon monoxide detector and smoke detector were tested at the time of the visit. LPA observed a 2A10BC fire extinguisher. LPA also observed a fireplace in the living room. LPA observed the fireplace to be screened and safety latches were installed. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). Applicant completed health preventive and safety training and has current pediatric CPR, first aid certificate which expires on 12/2023.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sabrina MartinezTELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2022
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: KIRSCHENSTEIN FAMILY CHILD CARE
FACILITY NUMBER: 197495090
VISIT DATE: 05/19/2022
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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: http://www.ada.gov/childqanda.htm

Exit interview conducted and report was reviewed with Applicant Maria Kirschenstein.

LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sabrina MartinezTELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022
LIC809 (FAS) - (06/04)
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