195700161-1-3-2024-58-CC-JLAO-CZ5UZE-20240103150125

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195700161
Report Date: 01/03/2024
Date Signed: 01/03/2024 03:01:38 PM

Document Has Been Signed on 01/03/2024 03:01 PM - 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:	LEVI FAMILY CHILDCARE		FACILITY NUMBER:	195700161
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	01/03/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:37 AM
MET WITH:	Sigalit Levi		TIME COMPLETED:	03:05 PM

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On 1/3/2024 Licensing Program Analysts (LPA)s Judy Laureano and Ranita Richmond conducted an announced inspection at the above mentioned home for the purpose of a pre licensing inspection. The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance with California Tittle 22 Regulations and California Health and Safety Codes. LPAs met with applicant Sigalit Levi, who guided LPAs on a tour of the home.

Per the application, at this time, the ages the applicant wishes to provide services for, are children 18 months to 3 years old- Monday through Thursday 8:30 am to 4:00 p.m. and Friday 8:30 a.m. to 2:00 p.m. Applicant is not available for overnight or weekend care. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes. Applicant is applying for a Large Family Child Care License with a max capacity of 14. Landlord consent and Landlord notification has been submitted. Applicant has been previously licensed at a different location.

Currently living in the home is applicant with three other adults, O. Levi, N. Levi and H.M. Levi.

LPAs toured the home inside and outside. The home is a two story home with 3 bedrooms and two 1/2 bathrooms a living room, dining room and kitchen. Home was observed with an enclosed front yard and backyard. Applicant confirmed families will enter the home through the side gate of the house. Side gate was observed with a combination lock and door bell.

Families will enter the side of the home that leads to the backyard. Back yard is covered with artificial turf and a variety of age appropriate outdoor toys. Yard was observed children size tables and chairs, plastic kitchen area and children’s outdoor toys. LPAs observed children high chairs outside.

Bedroom 3/ designated as family day care room was observed and inspected. Applicant confirmed room will be used for activities. LPAs observed children size table and chairs, a closet with program materials and a variety of children’s toys. LPAs observed applicant

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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: LEVI FAMILY CHILDCARE	FACILITY NUMBER: 195700161
	VISIT DATE: 01/03/2024

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test the carbon monoxide and smoke detector in the room. A fire extinguisher was observed near the door that leads to the hallway. Fire pull station was observed near the door that lead to the back yard. Parent board was observed in the space with all the necessary posting. First Aid kit was observed in the space. A hallway outside bedroom 3/ family day care room was observed. Hallway was observed with a pantry closet. Hallway leads to the bathroom that children will use.

The bathroom was observed and inspected. LPAs observed a changing table next to the sink. Cabinet under the sink was inspected and observed with a safety latch. Sink, toilet and shower were observed and inspected. All electrical outlets were covered. Stackable dryer and washer were observed in the bathroom. LPAs reminded applicant to add a handwashing sign to ensure children wash their hands properly.

Outside the bathroom a side door was observed that leads to the backyard. Large living room space was observed and inspected. Living room is located next to the stairs that lead to the 2^nd floor. Living room is separated in two areas. The space located near the sliding door with the fire place has been designated as day care space. LPAs observed a variety of children’s books and toys. Children size tables and chairs were observed in the space. The area was observed with a bar area that was has a safety gate in place, making the area inaccessible. LPAs requested a barricaded to be added to the fire place in the living room. Applicant confirmed living room will be used for napping and eating.

LPAs observed a safety gate outside the first part of the living room. Safety gate separates the day care space and the living room area. The second half of the living room was observed and inspected. Area was observed with adult size couches and a coffee table. The area has been designated as OFF LIMITS and will only be used as a walkway to access the backyard, bathroom and bedroom 3/family day care room.

Next to the second part of the living room the dinning room and kitchen area were observed. Both areas have been designated as OFF LIMITS to the children in care. Dining room was observed with a dining room table and six chairs.

LPAs observed the kitchen area next to the dining room. Kitchen area has been designated as OFF LIMITS to the children in care. LPAs are requesting a safety gate between the kitchen and hallway area. Applicant will secure safety gate to ensure children do not have access to the kitchen area.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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: LEVI FAMILY CHILDCARE	FACILITY NUMBER: 195700161
	VISIT DATE: 01/03/2024

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Under the sink cabinet was observed to have safety latches making the content inaccessible to the children in care. Knives and sharp objects were observed stored on the top cabinet near the sink area. Applicant confirmed that home will be responsible for providing meals and snacks. LPAs discussed the importance of making sure a system is in place where dietary restrictions and allergies are noted. LPAs encouraged applicant to contact their local resource and referral agency, Connections for Children, to inquire about local Food Programs and other resources in the community. LPAs are requesting a safety latch to be added to the top drawer near the sink and the top drawer near the stove.

LPAs observed applicant test the carbon monoxide and smoke detector located in bedroom3/ family day care room, dining room and second floor.

Stairs were observed between living room and hallway. Second floor was observed and inspected. Per the applicant, second floor is designated as OFF LIMITS to children in care. Second floor consist of bedroom 1, bathroom 2 and bedroom 2. LPAs requested that a safety gate be added on the top of the stairs and the bottom of the stairs. LPAs reminded applicant that all area designated as OFF LIMITS, doors will remain locked and/or closed during the hours of operations and/or while children are present.

The following requirements shall be submitted by 1/12/ 2024. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.

The following corrections need to be completed prior to licensure:
1. Repair small gate located by the bottom of side of the house.
2. Safety latch added to top drawers near the sink and stove in the kitchen.
3. Add barricade to the fireplace in the living room.
4.Complete livescan process for M. H. Levi

The following areas have been designated as OFF LIMITS:
1. Main entrance of the home
2. 1/2 bathroom located by the main entrance
3. 2nd half of the living room- safety gate located outside the first half.
4. Dinning room and kitchen area
5. 2nd Floor- bedroom 1 and 2 and bathroom.

Exit interview was conducted with applicant Sigalit Levi.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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: LEVI FAMILY CHILDCARE	FACILITY NUMBER: 195700161
	VISIT DATE: 01/03/2024

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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, 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.

Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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) or (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.

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. PIN 22-05-CCP Page Eight

LPA discussed the safe sleep regulations with 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. 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.

Applicant was informed of the MyChildCarePlan.org site, 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.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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: LEVI FAMILY CHILDCARE	FACILITY NUMBER: 195700161
	VISIT DATE: 01/03/2024

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Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

Immunizations: Commencing September 1, 2016, SB 792, 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. LPA discussed the influenza waiver during the inspection.

Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.

Applicant was made reminded that it is the applicant’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations. Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation.

Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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: LEVI FAMILY CHILDCARE	FACILITY NUMBER: 195700161
	VISIT DATE: 01/03/2024

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• In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
• A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
• Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)
• The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.
• Changes should be reported the to the Department as soon as they occur such as construction and remodeling, telephone number changes and/or if you move from home.
• Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference.
• Fire and safety drills must be performed every six months and documented for review by the Department.
• All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
• 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.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC809 (FAS) - (06/04)

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