197407068-6-8-2026-58-CC-NMOY-DUUPCZ-20260608111247

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197407068
Report Date: 04/03/2026
Date Signed: 06/08/2026 11:13:56 AM

Document Has Been Signed on 06/08/2026 11:13 AM - 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:	LEVI FAMILY CHILD CARE		FACILITY NUMBER:	197407068
ADMINISTRATOR/ DIRECTOR:	ITSHACK & ILANA LEVI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 762-0280
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 0	DATE:	04/03/2026
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:45 AM
MET WITH:	Ilana Levi, Licensee		TIME VISIT/ INSPECTION COMPLETED:	03:00 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	On 04/03/2026 at 11:45 AM, Licensing Program Analyst (LPA) Nathanael John Mooberry conducted an unannounced Annual Required Inspection. Facility is located at 12430 Sylvan Street, North Hollywood, CA 90616. LPA identified self and met with Ilana Levi, Licensee. LPA identified reason for visit and provided Entrance Checklist -Child Care Homes (LIC 126) to facilitate the inspection. At 11:50 AM, Licensee allowed entry into the facility and provided LPA a guided tour of inside and outside of the facility. There were 0 children with 1 Staff present. The facility is currently licensed for a capacity of 12, per Licensee they currently have 12 enrolled. The facility’s hours of operation are currently Monday through Friday from 08:00 AM to 04:30 PM. Required postings were observed posted in Classroom 1. Parent's Rights poster was missing. The Family Child Care Home(FCCH) consists of 1 Classroom. PAGE 1 of 4

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Nathanael Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

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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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: LEVI FAMILY CHILD CARE	FACILITY NUMBER: 197407068
	VISIT DATE: 04/03/2026

NARRATIVE

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Beginning at 12:10 PM, LPA observed the following in Classroom 1. The furniture, toys, and equipment were inspected for age appropriateness and were in good repair.

Cribs and Cots are provided for each child enrolled. Linens are are provide by the families of each child and are brought daily. Linens are sent home to be washed daily. The bathroom was inspected for good repair and had functioning toilet and sink. Each child brings a water bottle that is filled/refilled with filtered water at the facility. Availability of indoor drinking water was observed in classroom.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Per Licensee, there are no poisons on the property. Carbon monoxide and smoke detectors were observed and are operable. Disaster drill log was available, last drill was conducted on 03/111/2026.

Food is prepared for the children and brought to the classroom. Kitchen is off limits.

Outdoor play equipment is in a safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. There is adequate shade in the play yard.

All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic-free. Per Licensee, there are no firearms stored on the premises. LPA observed no pools or bodies of water at the facility.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Nathanael Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

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: LEVI FAMILY CHILD CARE	FACILITY NUMBER: 197407068
	VISIT DATE: 04/03/2026

NARRATIVE

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LPA reviewed staff records. The review of Staff records was documented on the LIC 859. Staff present did not have proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present did have proof against TB, measles, pertussis, and influenza. Licensee had certificate for training in CPR and Pediatric First Aid but certificate did not show authorized trainer..

Children’s Records were reviewed. Inspection of required forms was made and documented on the LIC 857. Children's roster was reviewed and is current. Three of five children's files were missing parent's rights document (LIC 995)

First Aid supplies were observed in the classroom. According to the Licensee, medication is not administered to children in care.

Licensee stated that if a child is found to be ill, they are separated from the other children, and the parent is contacted for the child to be picked.

This facility does not provide Incidental Medical Services – IMS. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care- centers/.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Nathanael Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

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: LEVI FAMILY CHILD CARE	FACILITY NUMBER: 197407068
	VISIT DATE: 04/03/2026

NARRATIVE

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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.

There were four Type B deficiencies cited during today’s inspection:
Facility Administration - Type B: 102416(c) - Licensee had Adult, Pediatric, and Infant CPR and 1st Aid Training Certificate, but certificate did not have required EMSA sticker.
Facility Administration - Type B: 102419(b) - Parents Rights not posted.
Records - Type B: 102419(d)(1) - Missing Parents Rights for three children Missing Parents Rights for three children
Records - Type B: 1596.8662(b)(1) - Missing current mandated reporter Training certificate.

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

Exit interview conducted and report was reviewed with Licensee, Ilana Levi.
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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Nathanael Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/08/2026 11:13 AM - It Cannot Be Edited

Created By: Nathanael Mooberry On 04/03/2026 at 02:25 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: LEVI FAMILY CHILD CARE	FACILITY NUMBER: 197407068
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/03/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in one out of one persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/17/2026
	Plan of Correction
1 2 3 4	Licensee states they have mandated reporter training that is not accessible today, but they will send to LPA by POC date.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in one out of one persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/17/2026
	Plan of Correction
1 2 3 4	Licensee will request EMSA sticker from trainer, if unable to provide, they will take EMSA approved Pediatric CPR / First Aid by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:

	Nathanael Mooberry
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/08/2026 11:13 AM - It Cannot Be Edited

Created By: Nathanael Mooberry On 04/03/2026 at 02:25 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: LEVI FAMILY CHILD CARE	FACILITY NUMBER: 197407068
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/03/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102419(b)

Admission Procedures and Authorized Representatives Rights

(b) The licensee shall post the PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in a prominent, publicly accessible area in the family child care home at all times children are in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in one out of one objects which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/17/2026
	Plan of Correction
1 2 3 4	Licensee took down Parents Rights Poster but will replace it and send photo by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:

	Nathanael Mooberry
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC809 (FAS) - (06/04)

Page: 7 of 8

Document Has Been Signed on 06/08/2026 11:13 AM - It Cannot Be Edited

Created By: Nathanael Mooberry On 04/03/2026 at 02:25 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: LEVI FAMILY CHILD CARE	FACILITY NUMBER: 197407068
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/03/2026

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
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in three out of five files which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/17/2026
	Plan of Correction
1 2 3 4	Licensee will provide parent's with parents rights, have them sign, and keep documents in the child's files by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:

	Nathanael Mooberry
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC809 (FAS) - (06/04)

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