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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313619
Report Date: 05/19/2022
Date Signed: 05/19/2022 02:28:39 PM

Document Has Been Signed on 05/19/2022 02:28 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LOPATIN, SIMONFACILITY NUMBER:
304313619
ADMINISTRATOR:LOPATIN, SIMONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(617) 331-8588
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
05/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Elizabeth Rendon and Alexi LopatinTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Alanna Gontarek conducted an unannounced case management incident inspection and met with Elizabeth Rendon, Licensee's Assistant who gave a tour of the facility. Census was taken. There were 2 infants and 10 preschool children present upon arrival. During this visit, other adults present were: Alexi Lopatin, Licensee's assistant, Maria Onofre, Supervisor, and Tien Friedberg, Licensee's Assistant. The purpose of this visit was to discuss the Unusual Incident that occurred on 05/06/2022. The incident was reported timely, on next business day on 5/9/22.
A review of staff criminal clearance records on this date indicated that all facility staff, or other individuals who required caregiver background checks, have received criminal record and child abuse index clearances or exemptions. Facility representative was reminded that all adults 18 and over, 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 Child Care Home Daycare. 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.

The Unusual Incident Report stated, On Friday, 5/6/22, S4 took a longer than usual break, about 40 minutes. S4 went outside for break, and when S4 came back, S1 and S2 could smell marijuana on S4. S2 arrived in the afternoon, after nap, because there were teacher conferences with some of the parents. S1, S2, and S3 were also there watching the kids after S4 returned from S4’s break. S1 and S2 stated S1 was acting fine with the children and stayed for the rest of the day. S4 was dismissed on 5/9/22.

During today's visit, 5/19/22, LPA conducted interviews with staff: S1, S2, and S3. During interviews conducted with staff, 3 out 3 staff interviewed stated, S4 was conducting S4's duties of cleaning and providing supervision to the children from approximately 3:00 p.m. to 5:30 p.m. S1 and S2 both stated that S4 seemed tired on 5/6/22, day of reported incident. S2 stated that S2 spoke with S4 during S4's shift, stating S4 looked absent minded. S2 asked S4 if anything was wrong, and S4 stated that S4 was tired. During interview with S1, S1 stated S4 smelled like marijuana when S4 returned from break but did not see S4 with marijuana, nor using marijuana. LPA used Language Links to conduct interview with S3 in Russian. Name: Tatiana Code: # 11822. During interview with S3, S3 stated did not communicate with S4 due to not
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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Alanna Gontarek
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LOPATIN, SIMON
FACILITY NUMBER: 304313619
VISIT DATE: 05/19/2022
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speaking English, and stated did not notice anything different about S4's behavior when S3 observed S4 after S4's break. During interviews conducted with staff, 3 out of 3 staff interviewed stated did not observe S4 using marijuana and/or did not see S4 with marijuana on the premises. No staff disclosures were made regarding S4 being a danger to the children. S2 stated S2 relieved S4 of S4's duties the following working day, Monday, 5/9/22, due to possibly being under the influence of marijuana and tardiness, also stating that S2 did not want to risk S4 returning to work if S4 was using marijuana. During interview with S2, S2 stated that during termination of S4, S4 stated, "What I do on my lunch, is not your business."

LPA attempted to interview 1 child today, 5/19/22. LPA was unable to qualify child due to child being non-responsive. LPA was unable to interview other children due to children napping.

LPA obtained termination paperwork for S4.



No deficiencies were cited on today's inspection.

Exit interview conducted with Facility Representative, Maria Onofre. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Facility representative’s signature on this form acknowledges receipt of these rights.

A Confidential Names list (LIC811) was provided during this visit.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in a visible location for the authorized representatives of children.

End of Report
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Alanna Gontarek
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022
LIC809 (FAS) - (06/04)
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