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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700226
Report Date: 01/03/2024
Date Signed: 01/03/2024 12:45:53 PM

Document Has Been Signed on 01/03/2024 12:45 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:MOVOZOVA FAMILY CHILD CAREFACILITY NUMBER:
195700226
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/03/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Yelena MorozovaTIME COMPLETED:
01:00 PM
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On 1/03/2024, Licensing Program Analyst (LPAs) Jeanine Lipsey and Ellorine Jankans and LPM Emiko Bell met with Applicant Yelena Morozova. The purpose of the visit was an announced Pre-licensing inspection at the home located at 5114 Balboa Blvd. Encino, to ensure that health, safety, and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Homes will be met. Applicant applied for a small family child care home and wishes to care for children ages 13 months to 8 years old. The proposed hours of operation will operate Monday – Friday 8:00 a.m.– 5:00 p.m. Family members residing in the home include the applicant and one child. Applicant stated that a cell phone with active service, will be the main contact number while children are in care. Entrance Checklist was provided to the applicant.

Analyst discussed the LIC282 Affidavit Regarding Liability Insurance with applicant.

Analyst 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. Analyst provided the following required postings: LIC610A Emergency Disaster Plan, PUB 394 Notification of Parents’ Rights Poster, and LIC 9148 Earthquake Preparedness Checklist. Analyst advised, once licensed, the applicant’s license shall be posted. Applicant was advised, a disaster drill log shall be posted with disaster drills completed at lease every six months.

Applicant completed preventive health and safety/Childhood Nutrition/ Lead Exposure Prevention on 10/04/23, Mandated Reporter training on 11/29/23. The applicant has current pediatric CPR/First Aid training completed on 4/29/23. Orientation was completed on 04/04/23.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MOVOZOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700226
VISIT DATE: 01/03/2024
NARRATIVE
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Applicant, guided analysts on a tour of the home. All areas identified on the home sketch were inspected, including but not limited to, off limit areas. Per applicant, off limit areas will be locked and in accessible. This home consists of 3 bedrooms, 2 bathrooms, living/dining room, laundry room and kitchen. Per applicant, the children will use the following areas: Living/Dining room, 1 bedroom and 1 bathroom.

Two of the bedrooms, the master bedroom bathroom, and the kitchen are off-limits to the children in care. A safety gate is installed to make the kitchen inaccessible. The stove, refrigerator, sink and counter space area were observed. The bathroom, with working toilet, 2 potty chairs, and sink was observed to be free of hazards and in good repair. Hand soap and paper towels for children use was accessible.

LPA observed a fireplace with a screen, rendering it inaccessible to children in care.

Living/Dining room was observed to have a child size table, chairs, and a variety of age-appropriate toys and materials. There were no fixtures, furniture, and equipment which have been banned or recalled by the United States Consumer Product Safety Commission. Analyst observed emergency water and first aid kit in the living room. Analyst observed the home to be clean and orderly, with heating and ventilation for safety and comfort. Per applicant, children will sleep in the on limit bedroom. Analyst observed applicant test the carbon monoxide/smoke detectors in the Living/Dining room, both bedrooms, the kitchen and the laundry room, they were in good working condition. Analyst observed a fire extinguisher (2A10BC) in kitchen with purchase date of October 15, 2023. Analyst observed there were no defects or conditions which might endanger the children. All electrical outlets in the home were covered. Analyst observed there were no poisons, detergents, cleaning compounds, medicines, and other items which could pose a danger, accessible to children. Per applicant, there are no weapons or firearms of any kind in the home currently. LPA did not observe any weapons.

Cribs and toddler beds were observed for napping. Analyst advised that there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Analyst advised that the placement of cribs or play yards shall not hinder entrance or exit to and from the space where infants are sleeping. Analyst advised that mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. Mattresses shall be made specifically for the size crib or play yard in which they are placed.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MOVOZOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700226
VISIT DATE: 01/03/2024
NARRATIVE
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Analyst advised that cribs or play yards shall be free from all loose articles, objects, bumper pads shall not be used, and there shall be no objects hanging above or attached to the side of the crib. Analyst observed that both cribs have standard-size pillows in them; applicant was advised to remove them.

Per Health and Safety Code Sections 1596.846(b) and (c), analyst advised that baby walkers, bouncers, Johnny jumpers, trampolines, and saucer chairs are not permitted.

Analyst discussed when a child shows signs of illness, he/she shall be separated from other children until the nature of the illness determined. If it is a communicable disease, he/she shall be separated from other children until the infectious stage is over. The Isolation area will be located in the bedroom.

Children will utilize the backyard to play. Outdoor play area was observed to be fenced. Per applicant, when children are having outside time, she will ensure 100% supervision and never leave children unattended. There were no bodies of water present.

The applicant provided proof of control of property.

Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Analyst discussed that the applicant shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the applicant to be temporarily absent from the home, the applicant shall arrange for a substitute adult to care for and supervise the children during her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.



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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MOVOZOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700226
VISIT DATE: 01/03/2024
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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) or (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.

On 11/17/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Analyst informed applicant that smoking is prohibited on the premises of a family childcare home as specified in Health and Safety Code Section 1596.795(a).

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.



Analyst discussed the safe sleep regulations with the 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 resource.

Analyst 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.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MOVOZOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700226
VISIT DATE: 01/03/2024
NARRATIVE
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

The following corrections are needed before license will be approved:

1. Applicant back ground check must clear.

Exit interview conducted and report was reviewed with applicant Yelena Morozova.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC809 (FAS) - (06/04)
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