Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493810
Report Date: 06/28/2018
Date Signed: 06/28/2018 03:38:13 PM

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:SCHWARZKOPF FAMILY CHILD CAREFACILITY NUMBER:
197493810
ADMINISTRATOR:SCHWARZKOPF, ZOHARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 357-7712
CITY:TARZANASTATE: CAZIP CODE:
91335
CAPACITY:14CENSUS: 1DATE:
06/28/2018
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Zohar SchwarzkoffTIME COMPLETED:
12:00 PM
NARRATIVE
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This is an announced pre-licensing visit conducted by Margarit Sislyan Licensing Program Analysts (LPA). LPA met with applicants Zohar Schwarzkoff who guided analyst on a tour of the facility.
This is a 3-bedroom 3 bathroom one story single family home. The bedrooms are off limit. There is a converted garage in the back of the property with a permit.
The main care will be provided in the living room and in the converted garage. Rest of the house is off limit. The day care area has a separate entrance from the side of the house.
Family members residing at facility are: 2 adults and 1 child. The home was inspected for safety, comfort, cleanliness, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Per applicant, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons.
There is a water fountain in the front porch.

There are age appropriate toys and equipment on the premises. Applicant has provided proof of Preventative Health and Safety. CPR expires on 02/12/20. Applicant has submitted a disaster plan and demonstrated control of property at the above address by presenting Mortgage Statement.



The following were discussed: No smoking, no infant walkers, Johnny jumpers, exersaucers or any other item that falls into that category. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements. Fingerprint clearance, transfer process and capacity / ratios. Regulation 102416.3 was explained and discussed with applicant.

The following are needed before licensure.


· Fire extinguisher 2A10BC
· Water fountain shall be fenced with 5 feet fence.
· The cleaning compounds and sharp items shall be out of reach of children
· Fire Place shall be screened to prevent access by children.
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (424) 302-3048
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: ((42) 430-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2018
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: SCHWARZKOPF FAMILY CHILD CARE
FACILITY NUMBER: 197493810
VISIT DATE: 06/28/2018
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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
Update on Incidental Medical Services: Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag. Please see Child Care Quarterly Report on www.ccld.ca.gov
The applicant was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of $500 per non-cleared adult will be assessed. Applicant was informed that it is required by law to post the following in the facility:
● Emergency Disaster Plan (LIC 610A) - This must be posted in your home next to the telephone and
The Earthquake Preparedness Checklist (LIC 9148), must be attached to the LIC 610A and available
to the public.
● Notification of Parents' Rights Poster (PUB 394) - This poster must be placed in an area of the home
where all parents can see it
● Facility License, (LIC 203)-Your Family Child Care Home License must be posted in an area of the
home where it can be easily seen.
● Notice of Site Visit (LIC 9213) must remain posted for 30 days (during the hours that children are in
care) after each site visit by a licensing representative.
● Any licensing report documenting a type “A” citation must be posted for 30 days during the hours that children are in care.

● Any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Employee records must be maintained by the applicant and shall contain the following: LIC9052/Employee Rights, LIC 9108 Mandated Reporter Form, an employment contract or application containing the following information: Employees Full Name, Date of Birth, Driver's License Number, Date of Employment, Documentation of Health and Safety Training, Duties of the employee. Licensee is reminded that records for employees as well as children must be maintained for 3 years after separation for the FCCH.


For additional information and forms visit our website at: www.ccld.ca.gov
Exit interview
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (424) 302-3048
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: ((42) 430-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2018
LIC809 (FAS) - (06/04)
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