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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403941
Report Date: 03/02/2023
Date Signed: 03/02/2023 12:33:02 PM

Document Has Been Signed on 03/02/2023 12:33 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:POLAND FAMILY DAY CAREFACILITY NUMBER:
197403941
ADMINISTRATOR:POLAND, VICTORIA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 841-8467
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 2DATE:
03/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Victoria Poland, LicenseeTIME COMPLETED:
01:00 PM
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On 03/02/2023, Licensing Program Analyst (LPA) Adrian Risher conducted an Annual Inspection. LPA provided Licensee with the purpose of the visit and was granted access to the facility. LPA met with Victoria Poland, Licensee. LPA toured the inside and outside with the Licensee. LPA observed the home to be clean, safe, orderly and well ventilated. There were 2 children present at the time of the inspection. The operating hours are Monday thru Friday 6:30am to 6:00pm.

LPA observed the home to have a Living Room, Dining Room, Kitchen, 3 bedrooms, and 2 bathrooms. The Licensee utilizes the living room, dining room and detached garage areas as the day-care. The rest of the home is inaccessible to the children. The living room is used for daily activities and napping. The dining room is used for eating. The detached garage is used for daily activities and eating. LPA observed mats being used for napping. LPA observed age appropriate toys and equipment for the children.

Licensee states that there are no weapons in the home. Licensee reports that there are no pets in the home. The kitchen and bathroom areas were inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects. These items were made inaccessible to children. Cleaning supplies are stored in upper cabinets and locked cabinets in the kitchen.

LPA observed operable smoke detectors and carbon monoxide detectors throughout the home which were tested during inspection. The home is equipped with 1 (2-A:10-B:C) Fire Extinguisher and First Aid kit which includes thermometer and band aids .A wall heater is used to keep the home warm. Licensee stated fans are used to keep the home cool in warmer weather.

LPA inspected the outside area and observed age appropriate toys. There are no bodies of water at the home. LPA observed a play apparatus and play equipment in the outside play area. The outside play area is fenced all around.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: POLAND FAMILY DAY CARE
FACILITY NUMBER: 197403941
VISIT DATE: 03/02/2023
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 Licensee CPR card expires 03/2024. The licensee and assistants have required immunizations and has completed Mandated Child Abuse Reporter Training. Staff and children files were reviewed during inspection. LPA reviewed records related to earthquake drills and fire drills which were found to be current. All required Child Care Postings was observed on the Parent Board during inspection.

No deficiencies will be cited today

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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 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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Victoria Poland, Licensee

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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