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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404345
Report Date: 11/13/2025
Date Signed: 11/13/2025 02:27:41 PM

Document Has Been Signed on 11/13/2025 02:27 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:PETLITSKAYA FAMILY CHILD CAREFACILITY NUMBER:
197404345
ADMINISTRATOR/
DIRECTOR:		PETLITSKAYA, LYUDMILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 625-7521
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/13/2025
TYPE OF VISIT:Required - 3 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:57 AM
MET WITH:Lyudmila Petlitskaya, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:51 PM
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On 11/13/2025 at 9:57 AM, Licensing Program Analyst (LPA) Brittanee Cleveland arrived to conduct an unannounced annual inspection to the above facility. LPA identified self and met with the Licensee, Lyudmila Petlitskaya, who guided LPA on a tour of the facility The family childcare home’s operation hours are Monday through Friday from 8:00 AM to 6:00 PM. LPA observed seven children in care at the time of the inspection. Licensee did have two assistants working at the time of inspection

This is a one-story home which consists of 4 bedrooms, 4 bathrooms, kitchen, a kitchenette, dining room, living room, den, garage, front yard, and fenced backyard area. Per Licensee, areas off limits to the children and parents include the dining room, kitchen, all bedrooms, 3 bathrooms, and garage. The children’s play activities take place in the den which is connected to the kitchenette and children’s restroom. Per licensee, the living room is used as the isolation room for children who become sick while in care. Licensee provides meals and snacks for children.

Individuals who reside in the home were noted and discussed. The Licensee states that there are two assistants that work every day. Every Thursday, the children have special arts, gymnastics, and music class that requires a teacher to come in for 45 minutes to teach.

Licensee states there are no firearms stored in the home.

All areas identified on the facility sketch that are accessible to children were inspected for safety, comfort, and cleanliness. There is a telephone service via a cellphone this is used and stays at the facility during the hours of operation. There is central ventilation and heating. Safe toys, play equipment and materials were observed. -- Page 1

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Brittanee Cleveland
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2025
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: PETLITSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197404345
VISIT DATE: 11/13/2025
NARRATIVE
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Disinfectants, cleaning solutions, medications and other items that are dangerous to children, were inaccessible to children. All poisons are locked in a cabinet in the kitchenette area and is inaccessible to children. Carbon monoxide and smoke detectors were observed are operable. General sanitation was observed. LPA did not observe any walkers, baby bouncers, inclined chairs, baby saucers, or any similar items at the facility.

The valve on the required 2A 40BC fire extinguisher indicates fully charged and was purchased on June 2025, per the service tag. LPA informed Licensee that the extinguisher is to be serviced every year or a new one is to be purchased.

Licensee states that there are two toddlers enrolled. These toddlers can sleep on cots without any safety problems. One child was observed using a pacifier to go to sleep. The pacifier is not attached to child and has nothing hanging from it. Each toddler has a sleep checklist that is signed by staff every 15 minutes. The toddlers are changed on a changing table near the children’s restroom. At the time of inspection there are no infants (ages 0-12 months) enrolled. No play yards or cribs were observed by LPA.

For outside play time, children use the fenced backyard area. The play area was observed to be fenced. LPA observed outdoor toys and other materials children can play with, in good condition. LPA advised licensee that all equipment and fencing shall remain in good conditions for the safety of children.

Licensee and assistants were observed to be operating within capacity limitations. LPA did not observe any children left in parked vehicles. Car seats are only to be used for transportation. LPA did not observe any children sleeping in car seats.

The licensee and assistants have completed training for preventative health practices including pediatric first aid and CPR. The licensee’s CPR and pediatric first aid expires in March 2026 and June 2027 (for Licensee). There are first aid supplies that were inspected by LPA. LPA advised licensee that when a child shows signs of illness, they shall be separated from other children.

Children’s records were reviewed, including emergency information and were observed to be complete.

The licensee and assistants do have proof of immunizations against influenza, pertussis and measles.

LPA observed that licensee does have proof of the Mandated Reporter training and certificates on file. LPA informed Licensee and assistants must update Mandated Reporter certificates every two years. -- Page 2

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Brittanee Cleveland
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
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: PETLITSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197404345
VISIT DATE: 11/13/2025
NARRATIVE
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All homes shall conduct fire and disaster drills at least ever once every six months and document the date for each drill. Licensee stated a fire/disaster drill was conducted on October 24, 2025, according to log.

LPA did not observe any pets in the home.

LPA did observe a pool at the home. This pool is secured by a five-foot five-inch fence that is double locked. Licensee stated that the pool is four to six feet, but it is off limits to children in care. LPA did not observe a pool cover or water alarm. LPA did not observe a 12-foot hook or life circle at the time of inspection. Due to these observations, LPA has issued a Type B deficiency for being a potential health and safety risk to children in care. LPA has requested for this to be corrected within the next 30 days.

Emergency Disaster Plan, Parents Rights, and Facility License were observed to be posted.

Smoking is prohibited in a licensed family childcare home. Per licensee, no one smokes in the home.

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.

Licensee [or facility representative] 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.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [or facility representative] 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. --- Page 3

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Brittanee Cleveland
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: PETLITSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197404345
VISIT DATE: 11/13/2025
NARRATIVE
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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 [or facility representative] 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.

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.

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

Exit interview conducted and report was reviewed with the licensee, Lyudmila Petlitskaya.

--- Page 4

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Brittanee Cleveland
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 11/13/2025 02:27 PM - It Cannot Be Edited


Created By: Brittanee Cleveland On 11/13/2025 at 02:06 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: PETLITSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197404345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(1)(B)(i)(I)
Pool Safety
(i) (I) An approved safety pool cover that is manually or power operated and meets the performance standards of ASTM International Standard F1346-23.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/12/2025
Plan of Correction
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LPA has requested photo of the new pool equipment from Licensee byt December 12, 2025.
Type B
Section Cited
HSC
1596.814(a)(1)(B)(ii)(I)
Pool Safety
(ii) (I) An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/12/2025
Plan of Correction
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LPA has requested photo of the new pool equipment from Licensee byt December 12, 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.
Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:
Brittanee Cleveland
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/13/2025


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 11/13/2025 02:27 PM - It Cannot Be Edited


Created By: Brittanee Cleveland On 11/13/2025 at 02:06 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: PETLITSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197404345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(2)(A)
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: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (A) A life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/12/2025
Plan of Correction
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LPA has requested photo of the new pool equipment from Licensee byt December 12, 2025.
Type B
Section Cited
HSC
1596.814(a)(2)(B)
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: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (B) A rescue pole with a body hook and a minimum fixed length of 12 feet.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/12/2025
Plan of Correction
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2
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LPA has requested photo of the new pool equipment from Licensee byt December 12, 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.
Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:
Brittanee Cleveland
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/13/2025


LIC809 (FAS) - (06/04)
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