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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336301310
Report Date: 07/09/2025
Date Signed: 07/09/2025 11:24:10 AM

Document Has Been Signed on 07/09/2025 11:24 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:PAVLOV FAMILY CHILD CAREFACILITY NUMBER:
336301310
ADMINISTRATOR/
DIRECTOR:		PAVLOV,LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(425) 387-2234
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
07/09/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee, Laura PavlovTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On July 9, 2025, at 9:00 AM, Licensing Program Analyst (LPA) Brian Morris completed an announced Case Management visit requested by Licensee Laura Pavlov to discuss Pavlov FCCH #336301310 the installation of an in-ground swimming pool, and the 5-Foot mesh/rod iron gate surrounding the in-ground swimming pool and embankment wall.

During the inspection, LPA made observations of a rectangular style in-ground swimming pool (photos uploaded to IECC Commons), located in the back yard. This LPA observed the backyard small walkway area, heading towards the facilities Air Conditioning (AC) unit, the walkway measures 36 inches (3-feet), Licensee Pavlov plans to install the 5 foot mesh/rod iron gate on the south portion of the small walkway area, preventing direct access to the in-ground swimming pool, which leaves enough space for a walkway and the mesh/rod iron gate will be inaccessible from the Dining room windows. This LPA observed two retaining walls with different heights in the backyard area of Pavlov FCCH, the higher wall measures 53 inches, and the lower wall measures 36 inches. LPA informed Licensee Pavlov, the 5 foot requirement when standing on the barrier wall, still needs to be honored, so adjustments to the 5-Foot mesh/rod iron gate need to be met, meaning the lower portion of the retaining wall with the 5-foot (60 inch) wall, will measure at 96 inches (8-feet) and the higher portion of the retaining wall will measure at 113 inches (9-foot, seven inches). Two Dining room windows are observed to look out into the backyard area, the smaller of the two windows cannot be opened from inside of the home, or outside of the home. This LPA observed, the larger window does have two sliding windows that can be opened, from inside the home. Licensee Pavlov pointed out the two electronic window sensors, which have been placed on the window to alert Licensee Pavlov once they have been opened. This LPA had Licensee Pavlov demonstrate the window alarms are functioning. Licensee Pavlov pointed there will be one self latching gate, with direct access to the in-ground swimming pool area.

NAME OF LICENSING PROGRAM MANAGER: Carlos Martinez
NAME OF LICENSING PROGRAM ANALYST: Brian Morris
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: PAVLOV FAMILY CHILD CARE
FACILITY NUMBER: 336301310
VISIT DATE: 07/09/2025
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LPA observed, the sliding glass door area leading out into the back yard is equipped with an electric alarm, which this LPA requested Licensee Pavlov demonstrate and the electric alarms in Pavlov FCCH are operating and were tested in the presence of this LPA. LPA provided the best practice feedback by notifying Licensee Pavlov of the new AB 2866 policy regarding daily inspections and a daily inspection log, which is now required of all FCCH homes with water features, swimming pools and Jacuzzis on grounds. Licensee was encouraged to utilize a swimming pool alarm that meets ASTM International Standard F2208. LPA additionally encouraged Water Safety training.

There were no deficiencies cited during today’s inspection.

LPA provided an exit interview to Licensee Pavlov, along with appeal rights and a Notice of Site Visit. LPA confirmed with Licensee Pavlov; the Notice of Site Visit is to be posted for 30 consecutive days.

NAME OF LICENSING PROGRAM MANAGER: Carlos Martinez
NAME OF LICENSING PROGRAM ANALYST: Brian Morris
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC809 (FAS) - (06/04)
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