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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414180
Report Date: 06/03/2020
Date Signed: 08/26/2024 12:35:47 PM

Document Has Been Signed on 08/26/2024 12:35 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:RUBIN FAMILY CHILD CAREFACILITY NUMBER:
197414180
ADMINISTRATOR:RUBIN, ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 342-3358
CITY:LAKE BALBOASTATE: CAZIP CODE:
91406
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/03/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Elena Rubin/LicenseeTIME COMPLETED:
04:25 PM
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On 06/03/2020 at 2:00 p.m.. Licensing Program Analyst (LPA) Silva Garibyan conducted an announced Case Management tele-inspection via FaceTime due to the COVID-19 pandemic shelter-in-place orders in the state of California. The purpose of the meeting was to ensure that health, safety and personal rights as required by Title 22 Regulations governing California Family Child Care homes are met by the Licensee. At the time of the visit, Licensee was present with two assistants ( associated to the facility) and 10 children ( no infants). The licensee provided a virtual tour via FaceTime of all the rooms. The facility has two rooms designated for a napping room, one for boys and and one for girls. LPA observed 5 children in the boys room and 5 children in the girls room. LPA noticed that the children were each napping on every other bed to respect and maintain the 6 feet apart social distancing rule. The licensee has individual children's beds in each of the designated sleeping rooms. LPA Garibyan observed both the licensee and the assistants were wearing face masks. When the licensee was giving the virtual tour, she even showed stations in each room and by the entry door which contained gloves, alcohol based sanitizers and other sanitation necessities. She then showed outside her facility where she had placed signs (primarily in Russian) which told parents to limit their visits and instructed them at which point they may not pass. The licensee explained that the masks, sanitation, and gloves were primarily donations from the parents and she has plenty for herself, the staff, children and parents who may need it. The licensee explained that due to COVID-19 she had only 3 children in care up until last week, it is only this week where the number of children has increased to 10.
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2020
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: RUBIN FAMILY CHILD CARE
FACILITY NUMBER: 197414180
VISIT DATE: 06/03/2020
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 The licensee also explained that she screens each child every morning before she allows them in the facility. LPA Garibyan explained to the licensee that she will be sending all resource materials, websites with information on COVID-19 and provider information notices along with this report.

The Fire Extinguisher (2A-10-BC) is mounted on the wall in the kitchen. There is a working smoke and Carbon Monoxide detectors located in the day care room. The First Aid kit was observed, and complete.

Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , Child Care Facility Roster (LIC9040), Emergency Disaster Plan (LIC610a), Lead Poisoning Facts/Potential Sources Of Lead/Effects Of Lead Exposure.

A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card.

Licensee was advised that an email will be sent with the report attached, which has been reviewed during the Tele-Visit. Licensee further advised that a read receipt via email shall be considered an acknowledgement that they are in receipt of this form and understand they licensing appeal rights as explained.
An exit interview was conducted and a copy of this report will be provided via email to licensees.







SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2020
LIC809 (FAS) - (06/04)
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