197494766-5-3-2021-30-CC-SGAN-C2NKBN-20210503074550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494766
Report Date: 04/07/2021
Date Signed: 05/03/2021 07:45:59 AM

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:	APPLE SCHOOL EARLY CHILDHOOD EDUCATIONAL CENTER		FACILITY NUMBER:	197494766
ADMINISTRATOR:	YELENA DOBRYNINA		FACILITY TYPE:	850
ADDRESS:	14123 VICTORY BLVD		TELEPHONE:	(323) 449-1378
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91401
CAPACITY:	60	CENSUS: 0	DATE:	04/07/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Yelena Dobrynina/Owner		TIME COMPLETED:	02:20 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 met with the owner, Yelena Dobrynina and conducted a site evaluation for the purpose of a change of ownership visit. Applicants provided a tour of the facility at 11:30A.M. The facility has been previously licensed as a sole proprietor, License # 197419404. The facility consists of 4 classrooms, Director's office, Teacher's lounge, and food preparation area. The facility will operate Monday through Friday; 8:00 am to 6:00 pm. The classrooms are primarily separated by age groups; identified as "Apple Seeds", "Green Apples", "Golden Apples", and "Red Apples". There are 2 bathrooms for children's use containing a total of 4 toilets and 4 sinks. There is a changing table inside one of the bathrooms. The bathrooms are accessible from the hallway and are located along the right side of the building. The staff bathroom is located near the Apple Seeds classroom. The following are the measurements: Preschool Indoor: Apple Seeds: (14.9 x 17.1) + ( 12.8 x 8.5 ) = 256.28 + 108.8 = 365.08 sq.ft./35 = 10.43 children Golden Apples: (39.8 x 13.6) - ( .8 x 8) = 541.28 - 6.4 = 534.88 sq. ft. /35 = 15.28 children Green Apples: ( 11.9 x 45.6 ) - ( .8 x 25) = 542.64 - 20 = 522.64 sq.ft./35 = 15 children Red Apples: 41.3 x 16.6 = 685.58 sq.ft./ 35 = 20 children Total indoor measurement for the 4 classrooms: 2,108.18 sq ft. / 35 = 60 preschool children

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021

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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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: APPLE SCHOOL EARLY CHILDHOOD EDUCATIONAL CENTER	FACILITY NUMBER: 197494766
	VISIT DATE: 04/07/2021

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Preschool outdoor measurement: ( 32.9 x 69) + ( 15.6 x 16.2) = 2,270.1 + 252.72 = 2,522.82 sq.ft./75 = 33 children.

Total toilet/sinks (4 toilets and 4 sinks) for a maximum capacity of 60 children.

Limiting factor at this time is the Outdoor space and available toilets and sinks which allows a maximum capacity of 60 children. The facility is ready for licensure at this time and will be approved for 60 children.

LPA observed fire extinguishers & evacuation plans posted. First aid supplies are located in the director's office and basic supplies in each classroom. Storage for children's belongings & bathroom facilities were inspected. There are cubbies for each class located inside each classroom. Medication and Discipline policies were discussed. Fire/Earthquake drills documentation were explained. Care & Supervision issues were addressed.
Meals will be prepared on site daily. Children will eat inside their classrooms. The food preparation area was inspected and has a sink with hot and cold running water, refrigerator with freezer, microwave oven, and crock-pots. Applicant is also considering the option of catering meals when enrollment increases. Disposal of food/debris were discussed. Storage areas were inspected for toxins/cleaning compounds inaccessibility. Proper food and cleaning products storage was discussed.
Drinking water is available in each room in the form of water pitchers and disposable cups. A water pitcher and cups will be taken outside for use when children are outside in the play area. The director's office and staff bathroom will be used as isolation areas for sick children. Control of property verified with a copy of the lease agreement.
Napping Equipment: Cots and mats are available for children in care. Cots and mats are equipped with sheets.

Staff/Children Files: LPA observed all CCLD forms (blank) in files. Staff files were observed with sections for personnel, qualifications and evaluations. Children files were observed with sections for admissions agreement, immunization, medication consent, and authorizations.
Postings: LPA observed bulletin board in the hall way for parents. Bulletin board will contain school updates and required postings by licensing (Facility License, Emergency Disaster Plan, Parents Rights Poster, Personal Rights Form)

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021

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: APPLE SCHOOL EARLY CHILDHOOD EDUCATIONAL CENTER	FACILITY NUMBER: 197494766
	VISIT DATE: 04/07/2021

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Medication: All medication will be located in the Director's office.

Outdoor play area was inspected. There is a canopy providing shade with tables and chairs available for rest. There are no bodies of water in the play area. All areas around or under high climbing equipment are cushioned with material that absorbs a fall.

Parents and authorized adult will sign children in and out using their original signatures.

The following was discussed during this inspection:

Licensee/Applicant was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
Licensee/Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation.
Licensee/Applicant was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and to never shake a baby to prevent the Shaken Baby Syndrome.
Applicant was also reminded that only children eating may be in highchairs and that car seats are utilized only for transportation.
The "Notification of Parent's Rights" (PUB394) was discussed with the licensee and the licensee was advised that it must be posted in an area of the home accessible to parents.
Licensee/Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541; Email Address: childcareadvocatesprogram@dss.ca.gov
Also, discussed was; Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. Exemption were also discussed

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021

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: APPLE SCHOOL EARLY CHILDHOOD EDUCATIONAL CENTER	FACILITY NUMBER: 197494766
	VISIT DATE: 04/07/2021

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Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

The following is required to continue the processing of the application for capacity of 60 children:

1) Fire Clearance with corrected capacity
2) Outdoor waiver approval

A copy of this report will be electronically mailed to the applicant for review and signature

A read receipt shall confirm as receipt of the electronically delivered report.

Applicant shall print and sign the report and mail the report to the licensing office, with an original signature.

If there are any questions or concerns, please contact the department at (424) 301-3077

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021

LIC809 (FAS) - (06/04)

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