<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700226
Report Date: 08/01/2025
Date Signed: 08/01/2025 05:02:52 PM

Document Has Been Signed on 08/01/2025 05:02 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:MOR0ZOVA FAMILY CHILD CAREFACILITY NUMBER:
195700226
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 8DATE:
08/01/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Yelena Morozova, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/01/2025 Licensing Program Analyst (LPA), Dawn Dowling arrived at 1:45 PM at the above residence for the purpose of conducting an unannounced Annual Random Inspection for capacity increase and was met by Licensee Yelena Morozova. There was another adult resident and Licensee child present. An Entrance checklist was provided. LPA observed 7 children in care being supervised by Licensee. Capacity as specified on the license is being maintained. Days and hours of operation are Monday through Friday 8:00 AM to 6:00 PM.

LPA Dowling observed the following required postings: License, PUB 394 Notification of Parents’ Rights Poster, LIC 9148 Earthquake Preparedness Checklist and LIC 610 Emergency Disaster Plan. Licensee provided LPA Dowling with verification of Disaster and Fire Drills, the last one conducted on 7/14/2025. Licensee reminded that Emergency Disaster and Fire Drill should be conducted once every six months.

Licensee provided LPA Dowling with the following documents prior to inspection:

  • Pediatric CPR/ First Aid Certificate taken 05/03/2025
  • Mandated Reporter Certificate taken 12/01/2023
  • Mandated Reporter Certificate taken 11/29/202

Licensee reminded that Pediatric CPR/First Aid must be issued by American Red Cross or American Heart Association , or by approved Emergency Medical Services Authority (EMSA) vendor. Licensee informed that Mandated Reporter Training and Pediatric CPR/ First Aid Training is taken every 2 years.

Page 1

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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)
Page: 2 of 5
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: MOR0ZOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700226
VISIT DATE: 08/01/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The home was toured with the Licensee for a health and safety inspection. The home consists of a Living Room (Main child care area) with a fireplace that has a screen covering it, dining room, Laundry room, 3 Bedrooms and 2 bathrooms, front yard and back yard. There is another residence next door with a different address 5112 Balboa Blvd., Encino, CA 91316. The home next door has a back yard with a pool that is not connected to Licensee's back yard, there is a gate that blocks neighbors from accessing Licensee's yard as well as Licensee is not able to access the neighbors yard.

The off limit rooms are the 2 bedrooms, and Master bathroom, Kitchen (gate making it inaccessible), Front yard, Laundry room.

The areas that Licensee uses is the Living Room (main day care room), dining room (Children have child size table that they eat meals and do lessons at), Bedroom#2 (napping room has 5 youth beds and 2 cribs for napping, bathroom, back yard (enclosed and gated) has canopy covering to shade children when weather is hot outside. Toys in the back yard were observed to be safe and in good condition.

Licensee resides in the home with her mother and son, mother is fingerprint cleared. There are no other adults residing in the residence.

Licensee provides food for the children. LPA Dowling reminded Licensee that food brought from home should be labeled with the child's name and properly refrigerated. LPA observed age-appropriate toys, learning materials and a coat rack for each child to hang their back packs on.

The required (2A10BC) fire extinguisher was observed in the kitchen and was purchased in January 2025. Per Applicant, there are no weapons or firearms in the facility.

The isolation area for a sick children waiting to be picked up will be dining room area away from other children in care..



The Licensee provided proof of control of property to LPA Dowling showing that mother was added to lease agreement. LPA Dowling received LIC 9151 Property Owner/Landlord Notification form and the signed LIC 9149 Property Owner/Landlord Consent form (LIC 9149).


Page 2
NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: MOR0ZOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700226
VISIT DATE: 08/01/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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.

Licensee provided the following documentation for her mother:
  • Immunization Record
  • TB test result


LPA Dowling reviewed children’s files and observed files were complete with:
· LIC 282- Affidavit Regarding Liability Insurance
· LIC 700 Identification and Emergency Information
· LIC 627 Consent for Emergency Medical Treatment
· LIC 995A Notification of Parent's Rights
· Immunization Record

LPA Dowling observed children in care were in caring and nurturing environment and treated with dignity and respect.

State law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. LPA did not observe any prohibit items in home.

Criminal Record Statement Family Child Care Homes

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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




Page 3
NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: MOR0ZOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700226
VISIT DATE: 08/01/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Safe Sleep regulation was discussed with licensee as well as the Child Care Licensing Safe Sleep webpage listed below that licensee can utilize as an additional resource.https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

The licensee is reminded to never shake a baby to prevent Shaken Baby Syndrome.

Licensee informed that only children eating may be in high chairs and that car seats are utilized only for transportation.

Medication :

LPA Dowling discussed medication with Licensee, Licensee does not give medication.

Incidental Medical Services (IMS) policy

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

LPA Dowing discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

There were no deficiencies cited during today's inspection. The Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days.

LPA Dowling informed Licensee that application will be forward to Licensing Program Manager (LPA) for approval of facility increase.

Exit interview conducted with Licensee. Licensee given Notice of Site Visit, this Report, Appeal Rights (LIC 9058) .

Page 4

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5