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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494453
Report Date: 09/10/2024
Date Signed: 09/10/2024 03:11:19 PM

Document Has Been Signed on 09/10/2024 03:11 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BARANOVA FAMILY CHILD CAREFACILITY NUMBER:
197494453
ADMINISTRATOR/
DIRECTOR:		BARANOVA, ALBINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 627-7391
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
09/10/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:KIMBERLY MORAN, TEACHERTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 09/10/2024 Licensing Program Analyst (LPA) Lisa Clayton arrived at the Baranova Family Child Care home unannounced to conduct a Plan of Correction visit. LPA Clayton was greeted by assistant/teacher Emberly Moran. LPA Clayton observed 11 children being supervised and cared for by 2 fingerprint cleared teachers.

On 07/03/2024, Licensee was cited for the following:
1. The licensee shall maintain a complete file for all children in care, containing all of the required LIC forms.

On 07/18/2024 LPA Clayton conducted a Plan of Correction visit to clear the above deficiency, but the children’s files were unavailable for review.

During todays inspection, LPA Clayton reviewed 13 children’s files, and 7 were found to be out of compliance as follows:
· 3 files are missing the Consent for Medical Treatment – LIC627
· 4 files have the incorrect Consent for Medical Treatment form (the files contained the consent form for Adult and Elderly Residential Facilities – LIC 627C)

Per Title 22 Regulations and Health and Safety Codes Deficiencies were cited today (see LIC 809D.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BARANOVA FAMILY CHILD CARE
FACILITY NUMBER: 197494453
VISIT DATE: 09/10/2024
NARRATIVE
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An exit interview was conducted. A copy of this report was provided to teacher Kim Moran.

LPA Clayton posted the Notice of Site Visit, which must remain posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/10/2024 03:11 PM - It Cannot Be Edited


Created By: Lisa Clayton On 09/10/2024 at 02:04 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: BARANOVA FAMILY CHILD CARE
FACILITY NUMBER: 197494453

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2024
Section Cited
CCR
102421(a)

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102421 Child's Records (a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).
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No later than 09/17/2024, Licensee will review childrens files and ensure that all files are complete and have all of the required licensing forms as listed on the LIC 311D. Licensee will ensure that forms in the childrens files are for the correct Licensing Program (Child Care Only).
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This requirement has not been met as observed by LPA Clayton review of 13 children’s files, and 7 were found to be out of compliance as 3 files are missing the Consent for Medical Treatment – LIC627 and 4 files have the incorrect Consent form (the files contained the consent form for Adult and Elderly Residential Facilities – LIC 627C)
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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:Karren Starks
LICENSING EVALUATOR NAME:Lisa Clayton
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


LIC809 (FAS) - (06/04)
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