195700224-6-5-2025-58-CC-LHEZ-DHCQCY-20250605120356

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195700224
Report Date: 06/05/2025
Date Signed: 06/05/2025 12:04:03 PM

Document Has Been Signed on 06/05/2025 12:04 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 CARE		FACILITY NUMBER:	195700224
ADMINISTRATOR/ DIRECTOR:	AYAZ NAMIYEV		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 448-6776
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	06/05/2025
TYPE OF VISIT:	POC	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:31 AM
MET WITH:	AYAZ "Isaac" NABIYEV, Licensee		TIME VISIT/ INSPECTION COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts(LPAs) Lilia Hernandez and Elicia Calvillo conducted a Plan of Correction (POC) inspection on 00/05/2025. The purpose of the visit was to ensure that the health, safety, personal rights, licensing conditions and limitations are as required by Title 22 Regulations. LPA at the facility at 3:25PM and met with AYAZ "Isaac" NABIYEV, Licensee, who guided LPA on a tour of the facility. Upon arrival, 2 infants and 3 preschool children were in care. 2 Assistants were also present. On 05/20/2025, Hernandez conducted an annual Inspection and Licensee was issued the following deficiencies: LPAs observed a portion of the fence that was in need of repair. Per Licensee, there is no second safety device for the in-ground pool. Per Licensee, there is no life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard, there is no rescue pole with a body hook and minimum fixed length of 12 feet and Licensee did not have a daily inspection log available for LPA to review. Licensee phone number on file was a mobile phone number that did not remain in the home when Licensee is away. LPA advise that the home shall maintain telephone services at all times. Phone number on file is not Licensee's number. Per Licensee, phone number belongs to their brother. Per Licensee, documentation of fire drills conducted was not available for review. LPAs observed loose items and items hanging from the play yards. Per Licensee, 3 of 3 staff do not have proof of TB clearance, measles, pertussis and influenza on file. LPA Hernandez observed 6 of 6 children's files to be incomplete. Licensee was not able to provide a sleep log for infant in care. ---Page 1 of 2

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Lilia Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025

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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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: NABIYEV FAMILY CHILD CARE	FACILITY NUMBER: 195700224
	VISIT DATE: 06/05/2025

NARRATIVE

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During today's inspection, LPAs observed disaster plan posted at the entrance of the facility. Licensee was also able to provide proof of fire drill conducted and logged. Last fire drill was conducted on 5/23/2025.

Licensee provided LPA Hernandez the updates to the facility's phone number for the telephone service that will be at the home at all times. Phone number was called and LPA Hernandez was able to verify that phone number was in service.

LPA Hernandez was able to verify that both Assistants present completed the mandated reporter training. LPA Hernandez was able to verify that both Assistants present had proof of immunization's for measles, pertussis, influenza and TB clearance. Licensee provided LPA Hernandez an written declaration disclosing that staff will not be present to provide care unless all required documentation is available at the facility for review.

LPA Hernandez observed a the pool fence to be in good repair. LPA Hernandez observed a second safety device for the in ground pool ASTM International Standard F2208 (photo taken). LPA Hernandez observed a life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard. LPA Hernandez observed a rescue pole with a body hook and minimum fixed length of 12 feet. Licensee provided LPA Hernandez proof of daily inspection log of the pool conducted in the AM prior to children arrival to care for review.

LPA Hernandez reviewed a sample of children’s files and observed files were complete with LI700 Identification and Emergency information, LIC627 Consent for Emergency Medical Treatment, and LIC995 Notification of Parents Rights and immunization records for children, and LIC 9224 Acknowledgement of Receipt of Licensing Reports for Type A deficiencies issued on 05/20/2025. Licensee was not able to provided LPA Hernandez verification of documentation maintained for infants in care that includes date, infant's name, or time of each 15 minute check.
Licensee was assessed with a civil penalty for failure to correct the deficiency issued on 05/20/2025.

The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with AYAZ "Isaac" NABIYEV, Licensee. ---Page 2 of 2

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Lilia Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025

LIC809 (FAS) - (06/04)

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