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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494680
Report Date: 04/13/2022
Date Signed: 04/13/2022 11:37:45 AM

Document Has Been Signed on 04/13/2022 11:37 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SKRYPNYK SHEVCHUK FAMILY CHILD CAREFACILITY NUMBER:
197494680
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
04/13/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Anton SkypnykTIME COMPLETED:
11:52 AM
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On 04/13/2022 at 9:45AM Licensing Program Analyst (LPA’s) Laticia Thompson arrived at the home of Anton Skypnyk & Larysa Schvchuk (Licensees) to conduct an Announced Increase In Capacity Inspection. Licensees guided the LPA on a tour of the home. The home operation hours are Monday-Friday 8am to 6pm. The licensing is applying for a Large family child care to care for a capacity of 14 children.

Licensees’ home is a one-story home. LPA entered though the front gate which leads to the front yard area which is off limits. LPA entered into the home from the front door. Licensees stated parents and children enters and exit through the front door. Upon arrival LPA observed 3 adults caring for 6 children. All adults has a criminal background clearance, licensees and assistant Elena Shpilbert. At the entrance of the hall way were Covid19 posting to prevent the spread.

The carbon monoxide/smoke detector alarm is located in the daycare living room area and is in operable condition.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SKRYPNYK SHEVCHUK FAMILY CHILD CARE
FACILITY NUMBER: 197494680
VISIT DATE: 04/13/2022
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The Parent board is located in the daycare living play area with the required documents according to Title 22 Regulations posted. Licensees states there are no firearms or weapons of any kind in the facility at the time of the visit

LPA inspected the kitchen area and observed safety latches on all cabinets. There were no sharp, hazardous material accessible to children.



The fire extinguisher is located in the laundry area and up to standards (2A10BC) that is fully charged. All door knobs throughout the home were equipped with safety knobs.

LPA inspected all off limits and on limits areas and did not observe any visual safety hazardous.

The home has working telephone service, Licensees agree to have cell phone available in facility during operating hours.

Poisons, detergents, cleaning compounds and medicines are stored where they are inaccessible to children.

The home has safe and age appropriate toys, play equipment and materials.
The Outdoor play area is properly fenced to prevent access to off limit areas. The sliding patio door located in the master bedroom (off limits) is secured to prevent children from accessing area
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SKRYPNYK SHEVCHUK FAMILY CHILD CARE
FACILITY NUMBER: 197494680
VISIT DATE: 04/13/2022
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LPA reviewed children files and found them to be in compliance.

LPA reviewed staff file and provided licensees with 311D to bring file to compliance.

Prior to visit a file review was conducted by LPA, Licensees has an Emergency Disaster Plan, Property Landlord Notification, Child Abuse Statement (LIC9108), and an Earthquake Preparedness Checklist. The Licensees has up-to-date Preventative Health and Safety/Childhood Nutrition, First Aid/CRP/AED, and Mandated Reporter Trainings.

LPA received a letter from assistant declining the flu vaccination. Licensee will provide a copy of assistant MMR vaccination by 04/20/2022

An exit interview was conducted with Anton Skrypnyk in which this report was read to him. LPA provided a copy of this report and Site Visit (LIC 9213) to licensees.

Change in Capacity is pending management approval.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
LIC809 (FAS) - (06/04)
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