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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700169
Report Date: 03/06/2025
Date Signed: 03/06/2025 01:19:52 PM

Document Has Been Signed on 03/06/2025 01:19 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:OVSEPJANOVA FAMILY CHILD CAREFACILITY NUMBER:
195700169
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
03/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:20 AM
MET WITH:Lia Ovsepjanova, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 03/06/2025, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Required Annual and Capacity Increase inspection at 20213 Lassen Street, Chatsworth, CA 91311. LPA arrived at the facility at 08:20 AM, identified self and met with Lia Ovsepjanova, Licensee, who guided analyst on a tour of the inside and outside of the facility. There were 2 children present at upon arrival and 7 children arrived later. LPA observed the number of children present at the facility exceeded the License Capacity of 8 children. LPA provided Licensee with a copy of the LIC125 Entrance Checklist -Family Child Care Homes to help facilitate the inspection. Licensee cares for children from ages birth to 12-year-olds. Facility hours of operation are Monday to Friday from 06:00AM to 11:00PM.

The licensee provided proof of control of property.

The family child care home is a one-story dwelling, includes combination living / dining room, kitchen, 4 bedrooms, 2 bathrooms, laundry closet, and no garage. There is a front yard that is off limits to children. There is a fenced outdoor play area on the side and back of the house. On the property is an Accessory Dueling Unit (ADU) with address 20215 Lassen Street, Chatsworth, CA 91311. LPA informed Licensee that the Facility Sketch -Yard will need to be updated to include the ADU location and address.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The children use the combination living / dining room for child care activities and eating. There are tables and chairs, toys and play items that are safe, clean, and appropriate for the ages of the children. Bedroom #2 is used for Infant Napping, there are three (3) portable cribs/ pack n’ play. Bedroom #4 is used for napping and there are a total of 12 beds, cots, and bed linens available for children.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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 10
Document Has Been Signed on 03/06/2025 01:19 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 03/06/2025 at 11:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(c)
Staffing Ratio and Capacity
(c) The total licensed capacity for a Small Family Child Care Home shall not exceed eight children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in the total number of children present was nine (9) which is above the capacity limit of eight (8) children which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2025
Plan of Correction
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Per Licensee they will maintain the capicity limit for eight (8) children per the facility license. Licensee will notify parents of childrent enrolled about exceeding the capcity limit for the facility by providing a copy of the facility report and collecting the LIC 9224 Acknowledgement of Receipt of Licensing Reports Form by the plan of correction due date of 03/07/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 2 of 10
Document Has Been Signed on 03/06/2025 01:19 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 03/06/2025 at 11:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 2 out of 2 infant children's files did not contain a Sleep Log and was not readily available upon request which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2025
Plan of Correction
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Per Licensee, they will completed a Infant Sleeping Log to record the physical check on the infant every 15 minutes and provide LPA wil a copy by the plan of correction due date 04/07/2024.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that 6 or 9 children's files did not contain an a Consent for Emergency Medical Treatment readily available upon request which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2025
Plan of Correction
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Per Licensee, they will obtain the Consent for Emergency Medical Treatment from the children's parents and provide a copy to LPA by the copy by the plan of correction due date of 04/07/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 03/06/2025 01:19 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 03/06/2025 at 11:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 9 of 9 children's files did not contain the LID 995A Norification of Parents' Rights readily available upon request which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2025
Plan of Correction
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Per Licensee, they will obtain the LIC 995A Notification of Parents' Rights from each child's parent and provide LPA a copy by the plan of correction due dae 04/07/2025.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 4 of 10
Document Has Been Signed on 03/06/2025 01:19 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 03/06/2025 at 11:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that 8 of 9 children's files did not contain LIC 282 Affidavit Regarding Liability Insurance and was not readily available upon request which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2025
Plan of Correction
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Per Licensee, the will obtain the LIC 282 Affidavit Regarding Liability Insurance from the children's parents and provide a copy to LPA by the plan of correction due date 04/07/2025.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 2 of 2 Infant children's files did not contain the LIC 9227 Individual Infant Sleeping Plan readily available upon request which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2025
Plan of Correction
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Per Licensee, they will obtain the LIC 9227 Individual Infant Sleeping Plan from the parents and provide a copy to LPA by the plan of correction due date 04/07/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 5 of 10
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: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169
VISIT DATE: 03/06/2025
NARRATIVE
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The children use the bathroom #1 located in the hallway near bedroom #2. The vanity cabinet holds hand soap and paper products, and no hazards were observed. LPA observed that the bathroom that children use was safe and sanitary.

Per Licensee, when a child shows signs of illness they will be separated from other children and isolated in the bedroom #2 away from other children.

The kitchen is made inaccessible with the use of child proof gates located at two entrances to the kitchen. The licensee provides food for children in care. Licensee stated when food is brought to the facility it is labeled with child’s name and stored properly. There is telephone service via a cellphone that stays at the facility during the hours of operation.

The outdoor play area is located at the back of the house, is fenced and there are no hazards to children present. LPA observed appropriate toys and other play equipment for children in care. LPA observed the ground is covered with cement and artificial grass and there is adequate shade with a covered patio.

Per Licensee, areas off limits to children and parents include kitchen, 2 bedrooms, 1 bathroom, laundry closet and are made inaccessible by use of door with a child proof lock to the only entrance to those area.

LPA did observe a front yard, per Licensee, the front yard is not used for child care activities and is used for dropping off and picking up children. Children enter the child care through the front door.

Per Licensee, there are no firearms, ammunition, or poisons on the premises. LPA did not observe any firearms, ammunition, or poisons during the inspection. Poisons, detergents, cleaning compounds, medicines, firearms, and other items which could pose a danger if readily available to children are stored where they are inaccessible to children.

Per Licensee, there is one (1) dog on the premises, during the facility hours of operations the dog is kept in bedroom #3 and is made inaccessible with the use of a child proof door lock to the only entrance.

Page 2 of 6
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 6 of 10
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: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169
VISIT DATE: 03/06/2025
NARRATIVE
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LPA did observe in the combination living / dining room a fireplace during the inspection. The fireplace has a glass enclosure and LPA observed it is not secured. Per Licensee, they will install a child proof lock. LPA did not observe an open face heater during the inspection.
LPA observed there is a working fire extinguisher size 1A 10BC and not the required 2A 10BC fire extinguisher. Per Licensee they will purchase the required fire extinguisher. There is a devise on the wall that Licensee stated is the pull fire alarm. There is a combination smoke / carbon monoxide monitor in the combination living / dining room.

There are currently two (2) infants in care. LPA discussed the safe sleep regulations with Licensee 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 discussed that an Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the Licensee has in care and included in the infant's file at the facility. LPA discussed with Licensee that documentation shall be maintained in the infant’s file and available for the Department to review. The documentation shall include the following: date, infants name, and the time of each 15-minute check.

LPA also informed Licensee 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.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Licensee was reminded that children in care are to be supervised at all times and made aware that children shall not be left in parked vehicles. Car seats shall only be used for transportation purposes and shall not be used for sleeping.

Page 3 of 6
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 7 of 10
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: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169
VISIT DATE: 03/06/2025
NARRATIVE
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Capacity as specified on the license is not maintained. During the facility inspection, there were 9 children at the facility which exceeded the facility capacity of 8 children.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

LPA reviewed a sample of children’s files and observed files were not complete and documented on the LIC857. There were 8 of 9 children’s files are missing LIC 282 Affidavit Regarding Liability Insurance, 6 of 9 children’s files are missing LIC 627 Consent for Emergency Medical Treatment, and 9 of 9 children’s are missing LIC 995A Notification of Parent’s Rights.

An emergency fire/disaster drill has not been completed and documented within the last 6 months. LPA advised Licensee that each family child care home shall conduct fire drills and disaster drills at least once every six months and shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home. Licensee’s Mandated Reporter Training was completed on 02/25/2025. Licensee’s pediatric CPR/First Aid expires on 01/2026.

There were one (1) personnel record for LPA and the personnel record was missing a current tuberculosis clearance or risk assessment.

LPA reviewed with licensee 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.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Page 4 of 6
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 8 of 10
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: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169
VISIT DATE: 03/06/2025
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, 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.

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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; 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.

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 platforms.

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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Page 5 of 6
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 9 of 10
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: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169
VISIT DATE: 03/06/2025
NARRATIVE
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During today's visit, per Title 22, Division 12, Chapter 3, of the California Code of Regulations, there are one (1) Type A citations being cited for section 102416.5(c) Staffing Ratio and Capacity. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent.) During this visit, the Licensee was provided with a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports Form and LIC 995A Notification of Parents’ Rights.

There were five (5) Type B citations being cited for sections 102425(j)(1) Infant Safe Sleep, 102425(c) Infant Safe Sleep, 102417(g)(7) Operation of A Family Child Care Home, 102419(d)(1) Admission Procedures and Authorized Representatives Rights, 102417(m)(3)Operation of A Family Child Care Home

Prior to Capacity Increase License approval the following corrections need to be completed by 04/07/2025.
  • Purchase a 2A:10 BC Fire Extinguisher.
  • Update Facility Sketch -Yard to include the location and address of the ADU on the property.
  • Secure the fireplace glass enclosure.
  • Obtain Assistant TB clearance or risk assessment.
  • Conduct fire drill and provided documentation of fire drill.
  • Provide Infant Sleep logs and LIC 9227 Infant Sleep Plan.
  • Update children's files.

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview was conducted with Lia Ovsepjanova, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
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