197418130-2-20-2025-58-CC-SGAN-DE3UZ6-20250220150102

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197418130
Report Date: 02/20/2025
Date Signed: 02/20/2025 03:01:15 PM

Document Has Been Signed on 02/20/2025 03:01 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:	OLSON FAMILY CHILD CARE		FACILITY NUMBER:	197418130
ADMINISTRATOR/ DIRECTOR:	OLSON, AMANDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 850-9678
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 15	CENSUS: 13	DATE:	02/20/2025
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:10 PM
MET WITH:	Amanda Olson, Licensee		TIME VISIT/ INSPECTION COMPLETED:	03:05 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 Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Required visit . LPA met with the licensee and toured the home inside and outside. There were 12 children present at the time of the visit. The adjacent property with a different address (11101 Archwood Place, North Hollywood, CA 91606) is also owned by the licensee (accessible from licensed property) and is currently vacant. The licensee was present with her three assistants. LPA toured the home inside and outside and a census was taken. Current facility sketch was reviewed. LPA confirmed with licensee off limits rooms identified on the facility sketch. All rooms identified as off limits were made inaccessible by locked doors, child safety knobs and child safety gates. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. All poisons are kept in a locked storage area. No poisons were observed during the inspection. detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The licensee's home is a single story home with 1 bedroom, an office, play room at the rear of the facility, living room/dining room used as an infant napping area, kitchen, and an attached converted garage. The garage has not been fully converted and licensee is fully aware that children may not eat or sleep in the garage. The home has 2 bathrooms; one of which is located inside the licensee's bedroom and the other is used by children and is accessible near the dining area. Main care for younger children is provided in the front of the home. Older children are cared for in the playroom at the rear of the home. Off limit areas include the licensee's bedroom, the office, the kitchen, and the garage. LPA observed tables, chairs and napping equipment. All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). Page 1

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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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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: OLSON FAMILY CHILD CARE	FACILITY NUMBER: 197418130
	VISIT DATE: 02/20/2025

NARRATIVE

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Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. The bathroom and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care.
Older children play room observed to have two children size tables, 12 children size chairs, 12 mats, and variety of age appropriate materials. The younger children play room in the front observed to have three mats, three cribs, two children size tables, six children size chairs, and variety of age appropriate materials. LPA Garibyan toured the outdoor area. The back yard has a swing set with a slide, securely mounted over sand. There is a cement area for bicycle play and there is a storage house for the bicycles. There is also a coop with six chickens in the back yard and two bunny houses with three rabbits in the front yard. The front yard is also used for play activities. The front yard is entirely fenced and no hazards were observed. Children's outdoor play equipment and toys are age appropriate and in good repair.
LPA also observed Licensee's and Assistants' current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (licensee's expires 01/2026). Licensee and assistants do not have a current Mandated Reporter Training. The fire drills are done every month. Last drill was conducted in January. Licensee provides meals and snacks. LPA discussed food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date. Licensee stated that a cell phone with active service in the home will be the main contact number while children are in care.
LPA observed in the living room the Parent Board with all necessary posting required ( Facility License (LIC 203), Emergency Disaster Plan (LIC610A), Notification of Parents' Rights Poster (PUB 394), If You see Something Say Something poster, Car Seat Safety poster). Child Care Facility Roster (LIC9040) was on file.
A review of the children's records was conducted and are found to have the following: LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC702, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card. Sleep log was missing in two files. Page 2

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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: OLSON FAMILY CHILD CARE	FACILITY NUMBER: 197418130
	VISIT DATE: 02/20/2025

NARRATIVE

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A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this 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 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 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.

Two infants are enrolled at this time. LPA discussed the safe sleep regulations with licensees 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.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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: OLSON FAMILY CHILD CARE	FACILITY NUMBER: 197418130
	VISIT DATE: 02/20/2025

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 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 Amanda Olson informed that there are no Registered Sex Offenders living in the facility.

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

Exit interview conducted and report was reviewed with the licensee Amanda Olson.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/20/2025 03:01 PM - It Cannot Be Edited

Created By: Silva Garibyan On 02/20/2025 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: OLSON FAMILY CHILD CARE	FACILITY NUMBER: 197418130
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/20/2025

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 interview and record review, the licensees did not comply with the section cited above in the licensee and assistants do not have a current Mandated Reporter Training, which poses a potential health, safety or personal rights risk to persons in care
	POC Due Date: 03/06/2025
	Plan of Correction
1 2 3 4	LIcensees will complete Mandated Reporter training and email the verification certificate of completion on or before the end of business day on 03/06/2025. LPA provided the trainining website address. www.mandatedreporterca.com

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above. There was no documentation or log available by the Licensee for the time of each 15 minute check for the two infants present, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/06/2025
	Plan of Correction
1 2 3 4	Licensee will generate a log for the infant enrolled and document the time of each 15 minute check and provide a copy of the log to CCL by the POC due 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.

SUPERVISOR'S NAME:

Betty Bell

LICENSING EVALUATOR NAME:

Silva Garibyan

LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

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