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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492996
Report Date: 08/30/2023
Date Signed: 08/30/2023 07:11:47 PM

Document Has Been Signed on 08/30/2023 07:11 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:VOROBYEVA FAMILY CHILD CAREFACILITY NUMBER:
197492996
ADMINISTRATOR:VOROBYEVA, GAYANEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(747) 400-9777
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
08/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 AM
MET WITH:G. VorobyevaTIME COMPLETED:
03:15 PM
NARRATIVE
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On August 30, 2023, Licensing Program Analyst (LPA), Veronica Wheatley and conducted an unannounced Annual Required Inspection and was met by Licensee, Gayane Vorobyeva. Days and hours of operation are currently Monday through Friday 7:00am to 6PM. No weekends.

LPA toured the home inside and outside and a census was taken. LPA observed 11 children on the premises. Current facility sketch reviewed and confirmed that the living room and two bedrooms are used for child care. The children use the main bathroom in the hallway. Three bedrooms are off-limits and made inaccessible. There is a swimming pool and jacuzzi on the premises. The pool has a mesh fence which is secure around the pool and jacuzzi. The self-latching gate is working properly. Per the licensee, there are no firearms or ammunition on the premises. Detergents, cleaning compounds, medication and other hazardous items were observed accessible in a bathroom located inside of one of the bedrooms. There is a working fire extinguisher, smoke detector, and carbon monoxide detector. The home has adequate heating and ventilation (central heat and air conditioning) for safety and comfort. There are no stairs in the home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number. LPA observed a children's roster.

LPA discussed Safe Sleep Regulations with licensee. Cribs and play yards will be kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants up to 2 years old every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. LPA observed two infants (under 2 years).
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: VOROBYEVA FAMILY CHILD CARE
FACILITY NUMBER: 197492996
VISIT DATE: 08/30/2023
NARRATIVE
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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training expired. Licensee’s pediatric CPR/First Aid expires on 6/2025. 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. Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA discussed with the licensee the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Exit interview. A copy of this report will be emailed to the licensee due to technical difficulties with printer.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/30/2023 07:11 PM - It Cannot Be Edited


Created By: Veronica Wheatley On 08/30/2023 at 04:44 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: VOROBYEVA FAMILY CHILD CARE
FACILITY NUMBER: 197492996

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370


This requirement is not met as evidenced by: LPA Wheatley observed two adult assistants supervising children today without fingeprints. Both of the assistants have children enrolled in the day care.
Deficient Practice Statement
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Based on LPA's observation and interview with the staff, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2023
Plan of Correction
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Licensee will get the employees (two assistants) fingerprinted as soon as possible. The employees are not allowed to work on the premises until they are fingerprint cleared. The licensee will send proof to the Department that the prints are cleared. A civil penalty is being assessed for the adults not being fingerprint cleared. The licensee will ensure that any future employees are cleared PRIOR to being allowed to work on the premises.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2023


LIC809 (FAS) - (06/04)
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