197417529-7-9-2024-58-CC-AMOY-D722B4-20240709171432

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417529
Report Date: 07/09/2024
Date Signed: 07/09/2024 05:14:43 PM

Document Has Been Signed on 07/09/2024 05:14 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:	BALENKO & VASILYEV FAMILY CHILD CARE		FACILITY NUMBER:	197417529
ADMINISTRATOR/ DIRECTOR:	BALENKO & VASILYEV		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 343-2365
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 7	DATE:	07/09/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:30 PM
MET WITH:	Tamara Balenko & Vladimir Vasilyev, Licensees		TIME VISIT/ INSPECTION COMPLETED:	05:30 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. Upon arrival LPA met with Tamara Balenko , Licensees, who provided tour of facility. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee the hours of operation are Monday-Saturday 8:00am - 6:00pm. There were 7 school aged children present. Also present was Vladimir Vasilyev, co-licensee. All adults present have been cleared and associated to the license. Individuals residing in the home were discussed and noted.

Facility is a single story dwelling with 2 bedrooms, 1 bathroom, living room, dining area in kitchen, and a single attached garage.

Children will have access to the living room (Art Studio), dining area and kitchen, bathroom, bedroom by the bathroom, covered patio and the back yard.

Off limit areas are: Bedroom 1, garage, front yard. Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating.

Rooms and areas of home that are off-limits need to be made inaccessible during operating hours. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form posted in wall by entrance to facility. LPA reviewed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

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: BALENKO & VASILYEV FAMILY CHILD CARE	FACILITY NUMBER: 197417529
	VISIT DATE: 07/09/2024

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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on September 2023, Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone and Lan line. The home is observed to be clean and orderly, there are toys and other age-appropriate material available.

LPA observed that cleaning compounds are in kitchen inaccessible to children in care. The bathroom that children use is located in the hallway and observed to be clean and free of hazards.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.

Per Licensee there are no firearms or weapons stored in the home. Isolation area for sick children waiting to be picked up is in living room, supervised and away from the other children.

The Licensee does not providing care for Infants. LPA discussed the safe sleep regulations with licensee 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. LPA also informed licensee 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.

Currently, children are using the backyard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with including a two level wooded and plastic play structure, and slide which is anchored to the ground with cushioned material under structure. LPA did not observe any objects that could be hazardous to children in care. The facility does not have a pool or similar bodies of water. Per licensee, no pets are in the home.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights.

Licensee and Co-licensee records were reviewed. Licensees have not completed the required Mandated Reporter Training AB1207 and the CPR/1st Aid on file does not have EMSA sticker.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

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: BALENKO & VASILYEV FAMILY CHILD CARE	FACILITY NUMBER: 197417529
	VISIT DATE: 07/09/2024

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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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA discussed water safety and provide supervision.

During the exit interview, the Licensees, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Tamara Balenko & Vladimir Vasilyev, Licensees

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/09/2024 05:14 PM - It Cannot Be Edited

Created By: Alicia Mooberry On 07/09/2024 at 04:43 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BALENKO & VASILYEV FAMILY CHILD CARE	FACILITY NUMBER: 197417529
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that the Pediatric CPR/1st Aid Certificate did not have EMSA stickers which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/23/2024
	Plan of Correction
1 2 3 4	Per licensee and co-licensee, they will call the company and request the EMSA sticker or retake the training with EMSA apporoved trainers, a copy of the EMSA appoved Pediatric CPR/1st Aid Certificate will be sent to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Valarie Cook

LICENSING EVALUATOR NAME:

Alicia Mooberry

LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

LIC809 (FAS) - (06/04)

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