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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493251
Report Date: 11/01/2024
Date Signed: 11/01/2024 01:21:58 PM

Document Has Been Signed on 11/01/2024 01:21 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:PERESECHANSKAYA FAMILY CHILD CAREFACILITY NUMBER:
197493251
ADMINISTRATOR/
DIRECTOR:		PERESECHANSKAYA, ZHANNETAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 800-0911
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
11/01/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:57 AM
MET WITH:Licensee Zhanneta PeresechanskayaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 11/01/24 at 8:57am Licensing Program Analyst (LPA), Jeanine Lipsey conducted an unannounced Required 3-year annual Inspection and was met by Licensee Zhanneta Peresechanskaya. Entrance checklist was provided. LPA observed nine children, to include 1 infant, being supervised by 2 staff. Days and hours of operation are Monday through Friday 7am to 6pm. Capacity as specified on the license is being maintained. Licensee owns home. LPA observed mortgage statement and Signed Affidavit Regarding Liability Insurance Is in the child files.

LPA observed the following required postings: License, LIC610A Emergency Disaster Plan, PUB 394 Notification of Parents’ Rights Poster, and LIC 9148 Earthquake Preparedness Checklist. LPA advised all LIC9213 Notice of Site Visits shall be posted for 30 days after each site visit. LPA advised, any licensing report documenting a Type A citation must be posted for 30 days. LPA advised a disaster drill log shall be posted with disaster drills completed at lease every six months. Fire drills were not being conducted.

This is a 2 story, 4-bedroom, 3-bathroom home with living room, playroom, kitchen, and attached garage. The second floor is off limits to children which include: 3 Bedrooms and 2 bathrooms. The areas that are accessible to children: are the children’s playroom, 1 bathroom, 1 bedroom, kitchen and the backyard for outdoor activities. LPA did not observe any safety features for the kitchen cabinets and drawers which pertain hazardous objects. The licensee will purchase a gate for the kitchen to reindeer it inaccessible to children in care.

LPA did not observe any poisons present during the inspection. Detergents, cleaning compounds, medication and other hazardous item were made inaccessible to children. Per applicant, there are no firearms, weapons or bodies of water on the premises. LPA observed the home to have some conditions which may endanger the children which include, the kitchen was missing electrical plug covers, part of the BBQ area fence was removed, and BBQ area has a gap big enough for a small child to fit through near the property wall, and the door to the off limit laundry room was open and did not have child safety lock to prevent entry.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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 8
Document Has Been Signed on 11/01/2024 01:21 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 11/01/2024 at 09:50 AM
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: PERESECHANSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197493251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the stairs is missing a barricade which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2024
Plan of Correction
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Licensee will purchase a gate by the Proof of correction (POC) date and send proof by email.
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited in that Fire drills are not being conducted which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2024
Plan of Correction
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Licensee will conduct a fire drill by POC date and send proof by email.
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2024


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 11/01/2024 01:21 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 11/01/2024 at 09:50 AM
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: PERESECHANSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197493251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in thay All 5 staff missing mandated reporter training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2024
Plan of Correction
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All staff will complete the Mandated Reported training by the POC date and send proof by email.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 4 of 5 staff missing, proof of T-dap, TB, and measels immunizations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2024
Plan of Correction
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Licenssee will have all staff take the training by the POC date and send proof by email.
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2024


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 11/01/2024 01:21 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 11/01/2024 at 09:50 AM
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: PERESECHANSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197493251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 3 of 5 staff missing flu vaccination/ declination which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2024
Plan of Correction
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Licensee will send copies of proof by POC date via email.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that proof of 15 minute checks being conducted for 1 infant are missing which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2024
Plan of Correction
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Licensee will send proof of 15 minute checks being conudcted by POC date via email.
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2024


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 11/01/2024 01:21 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 11/01/2024 at 10:31 AM
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: PERESECHANSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197493251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 3 of 5 staff missing personnel records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2024
Plan of Correction
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Licensee will create a file for all staff to include Full name, Address, phone number, date of employment birthdate and copy of ID and send to LPA via email by POC date.
Type B
Section Cited
CCR
102417(g)
PHYSICAL PLANT
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that Kitchen missing electrical plug covers, cabinets and drawers missing safety features, part of the BBQ area fence is removed, and BBQ area has a gap big enough for a small child to fit through near the property wall, the door to the off limit laundry room was open, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2024
Plan of Correction
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Licensee will send proof of all corrections via email by POC date.
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2024


LIC809 (FAS) - (06/04)
Page: 5 of 8
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: PERESECHANSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197493251
VISIT DATE: 11/01/2024
NARRATIVE
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The fireplace was non-working and rendered inaccessible with wood front. Where children are less than five years old are in care, stairs shall be fenced or barricaded. LPA did not observe a barricade in front of the stairs.

LPA observed fully stocked first aid kit. LPA Lipsey observed a working carbon monoxide detector in the hallway on the ceiling, LPA was able to hear a successful test. Smoke detectors are located in the playroom. Fire extinguisher 2A10BC was observed, located in the kitchen and was last serviced on 4/19/24. The home was observed to be clean and orderly with heating and ventilation. LPA observed safe toys, play equipment, and materials. LPA verified the home has a working telephone service.

LPA observed the outdoor area to be fenced with multiple play equipment in good repair. Licensee ensures that children in care are always supervised.

LPA reviewed record files and found that Licensee’s pediatric CPR/First Aid was completed on 10/29/24. All 5 staff have not completed the Mandated Reporter Training, 4 of 5 staff are missing proof of T-dap, TB, and measles immunizations, 3 of 5 staff missing personnel records, 4 of 5 staff missing lic 9052 and 3 of 5 staff missing flu declination. LPA advised Mandated reported training can be taken at www.mandatedreporterca.com.

For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-carecenters/.

On this date, 4/11/17, 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov.

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

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: PERESECHANSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197493251
VISIT DATE: 11/01/2024
NARRATIVE
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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.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

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-and­resources/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.

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. When a child is sick the isolation area will be in the living room.

(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.

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

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: PERESECHANSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197493251
VISIT DATE: 11/01/2024
NARRATIVE
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During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on LPA's observations, the following deficiencies listed on the attached LIC809D (deficiency page) are being cited in accordance with Title 22, Division 12, Chapter 3, of the California Code of Regulations. Deficiencies that are being cited need to be cleared to protect the children's health & safety.

Exit interview conducted and report was reviewed with the Licensee Zhanneta Peresechanskaya.

A notice of site visit was given and advised Licensee that it must remain posted for 30 days.

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

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC809 (FAS) - (06/04)
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