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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494453
Report Date: 10/11/2021
Date Signed: 10/11/2021 01:37:29 PM

Document Has Been Signed on 10/11/2021 01:37 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BARANOVA FAMILY CHILD CAREFACILITY NUMBER:
197494453
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
10/11/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Albina Baranova, Licensee TIME COMPLETED:
01:45 PM
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On 10/11/2021 12:45PM Licensing Program Analyst (LPA) Miranda conducted an announced visit, a Case Management inspection to the facility backyard. On the previously visit, LPA observed a wood playground with slide located at the backyard of the facility.

LPA met with the licensee and explained the reason of the visit. Upon arrival, LPA observed 5 children napping with licensee assistant present. (preschool age). LPA observed adults obtained a criminal record clearance and associated to the facility.


At 1:10PM LPA observed a parent drop off one child at the premises.

During this visit, LPA obtained photos of the wood playground and a copy of children's roster. The slide of the wood playground was observed without a certification label informing the age group that it is approved. Per Licensee application, Licensee caring of the age group of 2 years old to 6 years old.

Photos and documents will be review and LPA will contact licensee, for schedule a subsequencial visit or request additional documents.

A copy of this report, notice of site visit was provided to the licensee.


An exit interview conducted.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2021
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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