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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313619
Report Date: 03/23/2022
Date Signed: 03/23/2022 09:35:47 AM


Document Has Been Signed on 03/23/2022 09:35 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:LOPATIN, SIMONFACILITY NUMBER:
304313619
ADMINISTRATOR:LOPATIN, SIMONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(617) 331-8588
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY:14CENSUS: 10DATE:
03/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Elizabeth Rendon and Sonya Gee, and Maria OnofreTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of this facility for the purpose of adding Maria Onofre as con-licensee on the license. The Covid-19 Emergency Response questionnaire was reviewed and answered. LPA met with staff, Elizabeth Rendon and Sonya Gee at arrival time. Maria Onofre arrived during inspection. The licensee, Simon Lopatin was not present. Children arrived during inspection, LPA observed a total of 10 children of whom two were under 2 years old and 8 were over 2 years of age.
The licensee, Simon Lopatin had sent paperwork for Maria Onofre to be added on the license as co-licensee. LPA toured the home with Maria Onofre. She showed LPA that bedroom 2 out of 3 bedrooms upstairs is where she will be moving in. She said her lease agreement would end on 3/31/2022 in her current residence. The document was submitted to LPA during this inspection.
A review of staff records on this date indicated all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
On today's inspection, LPA discussed the Regulations with Maria Onofre. She understands Title 22 Regulations of family childcare home. Maria Onofre has submitted a request of change of address to the Department of Motor Vehicle (DMV) to this address. She agreed to send a copy of the original driver's license to indicate the current address to our Department when she receives it. An updated license to indicate Maria Onofre is the co-licensee with Simon Lopatin will be issued after final discussing in the office.
The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Maria Onofre was provided a copy of their appeal right (LIC 9058 01/2016) and their signature on this form acknowledges receipt of these rights. The facility was provided information about the E-Learning Modules available at https://ccld.childcarevideos.org
This report ends here.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022
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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