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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700088
Report Date: 05/25/2023
Date Signed: 05/25/2023 02:25:03 PM

Document Has Been Signed on 05/25/2023 02:25 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:AZHEUSKI & AZHEUSKAYA FAMILY CHILD CAREFACILITY NUMBER:
195700088
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/25/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:ANDREI AZHEUSKI - LicenseeTIME COMPLETED:
02:45 PM
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On 5/25/2023, Licensing Program Analyst (LPA) Suzette Ornelas conducted an announced Pre-Licensing Inspection at 14760 ARCHWOOD STREET Van Nuys Ca 91405. The purpose of the meeting was to ensure that health, safety and personal rights as required by Title 22 Regulations governing California Family Child Care homes will be met by the Applicant and to ensure correction from previous pre-licensing inspection was made. LPA met with Applicant, ANDREI AZHEUSKI & Aksana AZHEUSKIAYA (wife), who guided LPA on a tour of the inside and outside of the home. LPA observed 2 adults and 1 child in care (granddaughter).

LPA observed the following:

-Home does have a swimming pool, fenced. The fence is at least 5 feet high with a self-latching gate that opens away from the pool or body of water.

A copy of this report was provided to the Applicant. LPA will recommend facility is ready for license to LPM.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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