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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495053
Report Date: 04/14/2022
Date Signed: 04/14/2022 03:23:39 PM

Document Has Been Signed on 04/14/2022 03:23 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:SHAKHNAZAROVA FAMILY CHILD CAREFACILITY NUMBER:
197495053
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/14/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:DIANA SHAKHNAZAROVATIME COMPLETED:
01:00 PM
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On 4/14/2022 at 10:55am Licensing Program Analyst (LPA) Loyce Phillips conducted an announced Pre-Licensing inspection with Applicant, Diana Shakhnazarova. This inspection is due to an application received for a small family childcare license. Applicant guided LPA on a tour of the facility and intends to operate Monday through Friday from 8:00am to 6:00pm.

Applicant currently does not carry child-care insurance. The areas identified on the facility sketch were inspected. This is a 3 bedroom, 2 bathrooms home with living room, dining room, kitchen, laundry room and detached garage. Applicant resides in the home with spouse and 2 minor children. Applicant intends to provide breakfast, lunch and am/pm snacks to children. Areas that are accessible to children are as follows: Bedroom #3, bedroom #2, bathroom #2 and backyard. Off-limit areas to children: living room, dining room, kitchen, bedroom #1 and bathroom #1. This area is kept separate from bedroom #2, bedroom #3, bathroom #2 and the laundry room by a sliding door. The detached garage is also off-limits by a key door lock.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children are inaccessible. LPA observed age appropriate safe toys inside and outside. Applicant advised; children will nap on cots. Applicant has a carbon and smoke detector that was tested and operating. Medications are stored in an upper kitchen cabinet inaccessible to children. Knives and sharp objects were observed in a kitchen drawer inaccessible to children. Cleaning products are kept in the laundry room inaccessible to children.

LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.


Entrance Checklist was provided to the applicant.

809-C

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2022
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 3
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: SHAKHNAZAROVA FAMILY CHILD CARE
FACILITY NUMBER: 197495053
VISIT DATE: 04/14/2022
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resources. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. 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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletter and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at

https://www.cd.ss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

809-C

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: SHAKHNAZAROVA FAMILY CHILD CARE
FACILITY NUMBER: 197495053
VISIT DATE: 04/14/2022
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Based on today's inspection the following corrections are required prior to issuing a license:

- Fireplace made inaccessible


- Storage closet made inaccessible
- Kitchen made inaccessible
- A/C unit made inaccessible

Proof of corrections is to be provided to the Department by 4/21/2022.

Exit interview conducted and report was reviewed with Applicant, Diana Shakhnazarova.

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
LIC809 (FAS) - (06/04)
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