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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700224
Report Date: 09/08/2026
Date Signed: 09/08/2026 02:08:02 PM

Document Has Been Signed on 09/08/2026 02:08 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:NABIYEV FAMILY CHILD CAREFACILITY NUMBER:
195700224
ADMINISTRATOR/
DIRECTOR:		AYAZ NAMIYEVFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 448-6776
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 3DATE:
09/08/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:56 AM
MET WITH:Sevnivj NabiyevTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
NARRATIVE
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On 9/8/2026 at 11:56am, Licensing Program Analyst (LPA) Jeanine Lipsey conducted an unannounced Case Management - Deficiencies visit . LPA met with Staff Sevnivj Nabiyev who lead LPA on a tour of the facility. LPA toured the home and observed 3 children in care being supervised by 3 staff 8:30am. Licensee was not present during the visit. Per licensee, via phone, they were with their family member.

On 8/14/2026 the home was cited for not having a working pool alarm. On todays visit LPA observed the water level to be too low for the installed alarm. LPA did not observe the pool alarm to be working.
Per licensee, via phone, they purchased one but it did not work and they will purchase another one today. The facility will be cited a Type B.

On 8/14/26 the home was cited for staff missing immunization's and mandated reporter training. On todays visit LPA reviewed files and 4 of 5 staff is still missing the mandated reporter training and 2 of 5 staff is still missing their immunization's. The facility will be cited a type B.

On 8/14/26, Licensee failed to have the parents sign the LIC 9224 Acknowledgement of Receipt of the licensing report. Licensee will be cited a Type B.


Exit interview was conducted and report was reviewed with Sevinj Nabiyev. A notice of site visit was given and advised Licensee that it must remain posted for 30 days.
Betty Bell
Jeanine Lipsey
DATE: 09/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 09/08/2026 02:08 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 09/08/2026 at 01:11 PM
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: NABIYEV FAMILY CHILD CARE
FACILITY NUMBER: 195700224

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/22/2026
Section Cited
CCR
1597.622(c)

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Immunizations
(c) The family day care home shall maintain documentation of the required immunizations as set forth in this section, in the person's personnel record...
This requirement is not met as evidenced by:
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 Licensee will send proof of immunizations by POC date.
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Based on record review, 2 of 5 staff records review missing immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
09/22/2026
Section Cited
CCR1596.8662(b)(1)

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Administration of Child Day Care Licensing
a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...and shall complete renewal mandated reporter training every two years
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 Licensee will send proof of training by the POC date.
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This requirement is not met as evidenced by:
Based of record review 4 of 5 staff records, Mandated reporter training's expired which poses/posed a potential health, safety or personal rights risk to persons in care.
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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.
Betty Bell
NAME OF LICENSING PROGRAM MANAGER:
Jeanine Lipsey
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/08/2026 02:08 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 09/08/2026 at 01:31 PM
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: NABIYEV FAMILY CHILD CARE
FACILITY NUMBER: 195700224

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/22/2026
Section Cited
CCR
1596.814(a)

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Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements:
This requirement is not met as evidenced by:
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Per Licensee, they will purchase the correct alarm so when the water is disturbed, the alarm will sound.
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Based on observation, The water does not reach the alarm so it does not sound, which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
09/22/2026
Section Cited
HSC1596.817(a)(4)

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Site visits; posting of notices; contents; citations.
(4) A statement explaining that copies of the site visit report, including, but not limited to, violations.....
This requirement is not met by evidence by:
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Licensee shall place the signed Acknowledgement of Receipt of Licensing Report (LIC9924), in the child's file.
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Based on recored review 5 of 5 files, the licensee did not place the signed Acknowledgement of Receipt of Licensing Report (LIC9924) dated 7/28/26 in the childrens's file which poses/posed a potential health, safety or personal risk to children in care.
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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.
Betty Bell
NAME OF LICENSING PROGRAM MANAGER:
Jeanine Lipsey
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2026


LIC809 (FAS) - (06/04)
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