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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700088
Report Date: 05/22/2023
Date Signed: 05/22/2023 10:21:10 AM

Document Has Been Signed on 05/22/2023 10:21 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:AZHEUSKI & AZHEUSKAYA FAMILY CHILD CAREFACILITY NUMBER:
195700088
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/22/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:17 AM
MET WITH:ANDREI AZHEUSKI - LicenseeTIME COMPLETED:
10:20 AM
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On 5/22/2023, Licensing Program Analyst (LPA) Suzette Ornelas conducted an announced Pre-Licensing Inspection at 14760 ARCHWOOD STREET Van Nuys Ca 91405. The purpose of the meeting was to ensure that health, safety and personal rights as required by Title 22 Regulations governing California Family Child Care homes will be met by the Applicant and to ensure corrections from previous pre-licensing inspection were made. LPA met with Applicants, ANDREI AZHEUSKI & Aksana AZHEUSKIAYA (wife), who guided LPA on a tour of the inside and outside of the home. LPA observed 2 adults and 0 child in care.

LPA observed the following:

-Parent board with all required postings

-Fireplace screen securely secured to the wall

LPA provided applicant with copies of additional form to add to parent board.

LPA observed the pool gate is at least 5 feet high; however, is not self latching. LPA provided guidance to applicants on ensuring both gates that come with the pool gate are self latching and self close when released. LPA provided applicant with copy of the Operation of a Family Child Care 102417 Regulation that obtains pool information.

A copy of this report was provided to the Applicant. Final license determination will be made upon review by the Licensing Program Manager and correction of the above issue. Applicant will ensure pool gate is self latching on or before 6/5/2023.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2023
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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