<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494925
Report Date: 11/04/2021
Date Signed: 11/04/2021 02:06:43 PM

Document Has Been Signed on 11/04/2021 02:06 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:DAN FAMILY CHILD CAREFACILITY NUMBER:
197494925
ADMINISTRATOR:MICHAL DANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 210-9352
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/04/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Michal Dan/Applicant and Joseph Abergal/Applicant's SpouseTIME COMPLETED:
02:15 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
On 11/4/2021 at approximately 8:25 a.m. Licensing Program Analyst (LPA) Carolyn Tuba and Denise Maranda conducted an announced inspection with applicant Michal Dan for the purpose of a pre-licensing inspection of 6104 Warner Drive, Los Angeles, CA 90048. The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

The applicants are applying for a Large family childcare license with a max capacity of 14. Property owner/landlord consent (LIC 9151) is currently on file. The licensee rents/leases property; per applicant reside in the home. Lease agreement/control of property was received.

Fire clearance was granted on 9/15/2021 by L.A. City Fire Department- Institutions Unit.

Per the application, currently, the ages the applicants wish to provide services for children 6 months to 6 years old with the hours of operation, Monday through Friday 8:00 a.m. to 4:30 p.m. Applicants were informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
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: DAN FAMILY CHILD CARE
FACILITY NUMBER: 197494925
VISIT DATE: 11/04/2021
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
26
27
28
29
30
31
32
The home is located on a single property lot. The home is a single-story home with 4 bedrooms, 4 bathrooms, kitchen area, playroom, dining room, living room and attached garage. The living room, dining room, kitchen, bathroom #4, #3 & #1, bedroom #4, walk-in closet in bedroom #1 and attached garage is OFF LIMITS to the children. Bedroom #2 will be used only to access bathroom #2. The ON LIMITS areas of the house will be bedroom #1 and #3, bathroom #2 the playroom and outdoor backyard, per applicant the front yard will be off limits. The left sidewalk of the house will be used only in an emergency. Families will have access the home through the right sidewalk of the house.


Upon entering the home, LPAs observed the A/C is central air made inaccessible to the children in care. Entering the home, LPAs observed the fire alarm and carbon monoxide installed in the living room and the playroom. A carbon monoxide and smoke detector were observed and tested. LPAs observed a First Aid kit in the hallway next to the laundry room.

Kitchen cabinets were observed to have safety latches, except for one cabinet next to the refrigerator. The stove, refrigerator, sink and counter space area were observed and inspected. Knifes and sharp object were observed to be made inaccessible to the children in care. Applicants confirmed that facility will be providing meals and snacks.

In the hallway LPAs observed a Fire Extinguisher and parent board was not mounted on the wall. LPAs observed variety of age appropriate materials. LPAs observed two child size table and chairs, a variety of arts and craft materials and age appropriate toys. LPAs observed 14 napping mats. Applicants stated that they will be purchasing a pack and play for infant. LPAs discuss new Safe Sleep Regulations and directed applicants to the department’s website.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 2 of 8
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: DAN FAMILY CHILD CARE
FACILITY NUMBER: 197494925
VISIT DATE: 11/04/2021
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
26
27
28
29
30
31
32
The outdoor space is located towards the back area of the home. Applicants will walk children outside to an enclosed play yard secured by a wall off the main door from the playroom area. LPAs observed a large space with an outdoor age- appropriate toys. The area is covered with grass and some areas have artificial grass. LPAs observed the backyard to have a cover to provide shade in the patio/backyard area.

An exit interview was completed with the facility representative. A copy of this document is being furnished to the applicants. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.

The following was discussed with the applicant:


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 in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care 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

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

Mandated Reporter Training: 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. Licensee was reminded of their responsibility to report suspected child abuse.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: DAN FAMILY CHILD CARE
FACILITY NUMBER: 197494925
VISIT DATE: 11/04/2021
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
26
27
28
29
30
31
32
Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Be must be kept current, as well as the roster and Drill Log additional forms can be obtained from Maintained At The Facility - Family Child Care Home.

Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.

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.



Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.

Applicant was informed about SAFE SLEEP PRACTICES and was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome). LPA provided applicant with SAFE to SLEEP handouts. Applicant was also informed that the provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.


Safe Sleep Links:
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: DAN FAMILY CHILD CARE
FACILITY NUMBER: 197494925
VISIT DATE: 11/04/2021
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
26
27
28
29
30
31
32
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

Incidental Medical Services (IMS) policy was discussed. 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

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately.

In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: DAN FAMILY CHILD CARE
FACILITY NUMBER: 197494925
VISIT DATE: 11/04/2021
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
26
27
28
29
30
31
32
The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.

Changes should be reported the to the Department as soon as they occur such as construction and remodeling.

Telephone number changes and/or if you move from home or any scheduled changes.

Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference

Fire and safety drills must be performed every six months and documented for review by the Department.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

LPA advised the applicant how to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

Applicant will wait until facility opens to determine IMS needs: Incidental Medical Services (IMS) policy was discussed with the applicant. 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 homes and the ADA, available at: http://www.ada.gov/childqanda.html.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: DAN FAMILY CHILD CARE
FACILITY NUMBER: 197494925
VISIT DATE: 11/04/2021
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
26
27
28
29
30
31
32
Per applicant no bodies of water on the premises and LPAs observed no bodies of water during this inspection. LPAs observed a bunny, located in the attached garage (off-limit), per applicant, children in care will not have access to the bunny. Per Applicant no fire arms or ammunition. LPAs did not observe fire arms or ammunition.
The following is needed priory to licensure: Applicant will submit to El Segundo Regional Office no later than Tuesday, November 9, 2021 a new application form LIC 279 to update hours of operations, which will now be from 8:00 am – 4:30 pm. instead of 8:00 am – 5:00 pm.
Facility Sketch LIC999A – Applicant will submit an original form to LPA Tuba, to Tuesday, November 9, 2021 a revised Sketch – floor plan and yard.

Fireplace – Applicant will secure the fireplace barricade located in the living room.
Sleep equipment: applicant will provide a photo of playpen or crib.
Bedroom#3 – Applicant will bolt/secure on the wall.
Bedroom#2 – Applicant will place 4 latches to each drawer
Bathroom#2 – Applicant will make inaccessible the lotions, shampoos, conditioners and sink drawer’s applicant will place 4 latches.
Hallway – Cabinet contain laundry/detergent products, applicant will install one latch.
Hallway – Cabinet contain school supplies; applicant will install 6 latches.
Kitchen: Applicant will place a latch on the bottom drawer next to the refrigerator.
Swing – Per applicant declaration, will be use only on the weekends and after day care hours for her own children. Applicant will remove the swing seats and submit to LPA Tuba.
Emergency Preparedness Disaster supplies – Applicant will store a 3 day: supply of nonperishable food (including juice, canned food items, snacks, and infant formula), radio, flashlight, extra-batteries, heavy gloves, trash bags, and tools.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: DAN FAMILY CHILD CARE
FACILITY NUMBER: 197494925
VISIT DATE: 11/04/2021
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
26
27
28
29
30
31
32
tools.
Sidewalk – Applicant will place on the floor sign to indicate walking area, due to gap in the pathway to access underneath of the house.
Front gate – The front gate located on the right side of the house; applicant will install on the bottom of the gate a latch.
Play yard – cover holes located at the backyard area.
Documents to be posted in your family child care – During this visit, LPAs provided the following forms: LIC9148 Earthquake Preparedness Checklist and PUB394 Notification of Parents’ Rights. Applicant will create one visual space on her premises and posted the following forms: LIC610, LIC9148, PUB394 along with the license certificate.
· Emergency disaster supplies - Applicant will provide photo of radio with receipt.
LPA will make arrangement with applicant to conduct case management corrections of the recommendations no later than Tuesday, November 9, 2021 at 8:30 am. Exit interview was conducted with Michal Dan, applicant.
A copy of this report and all other Licensing reports must be made available to the public for 3 years
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 8 of 8