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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494846
Report Date: 11/29/2021
Date Signed: 11/29/2021 07:34:53 PM

Document Has Been Signed on 11/29/2021 07:34 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:LEVI FAMILY CHILD CAREFACILITY NUMBER:
197494846
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/29/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH:Adi LeviTIME COMPLETED:
10:30 AM
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Margarit Sislyan, Licensing Program Analyst (LPA) conducted a site visit to observe the corrections before licensure.

LPA toured the facility inside and outside. this is one story single family room with 3 bedrooms and 2 bathrooms and attached converted garage with permit. The main care will be provided in the converted garage. There is a full bathroom in the day care area and a little kitchenette with sink and refrigerator.
The main care will be provided in the converted garage. Rest of the house is off limit. There is separate entrance to the day care area. The outdoor area designated to the day care children was separated from the rest of the backyard with wooden fence.
LPA observed that licensee has a dog, Pit Bull. Licensee stated that the dog will not have an access to the day care area. The dog has all required shots.

LPA observed:
  • Fireplaces in the living room was screened to prevent access by children (the area is off limit).
  • There is working carbon monoxide detector device in the day care area
  • Permit of occupancy for the converted garage was provided to CCLD.

License for Small Family Child Care Home will be granted.

Exit interview
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Margarit Sislyan
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2021
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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