197494846-2-22-2023-58-CC-JLAO-CPAUM2-20230222144138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494846
Report Date: 02/21/2023
Date Signed: 02/22/2023 02:42:36 PM

Document Has Been Signed on 02/22/2023 02:42 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:	LEVI FAMILY CHILD CARE		FACILITY NUMBER:	197494846
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 11	DATE:	02/21/2023
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Adi Levi		TIME COMPLETED:	12:30 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 2/21/2023 at approximately 10:00 a.m. Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection and was met by Adi Levi located on 6650 Melvin Avenue, Reseda, CA 91335. Facility operates Monday through Thursday 8:30 a.m. to 4:00 p.m. and Friday 8:30 a.m. to 3:00 p.m. Currently licensee cares for children ages 2 years old to 5 years old but is available for infant care- birth to 5 years of age, LPA toured the home inside and outside and a census was taken; 11 children were present during the inspection and one assistant with licensee and licensee's husband. LPA issued a Type A ciation-Staffing Ratio and Capacity - Type A: 102416.5(a) – please see LIC 809 D. The home is a single-family home with a daycare room, guestroom/office, 2 bedrooms and 1 1/2 bathroom, a living room, dining room, kitchen and front yard and back yard. Licensee confirmed the following areas are used for day care: daycare room and ½ bathroom. Licensee uses the kitchen to prepare meals and snacks, but children are not allowed in the space. Front yard and side of the home has been designated as outdoor area for the daycare. The following areas are confirmed as OFF LIMITS: guest room/office, Bedroom 1, Bedroom 2, full bathroom, dining room, kitchen and living room. LPA observed a barricaded fireplace in the dining room, area designated as off limits. Living room was observed to have a sliding room door that leads to a separate backyard that has been designated as OFF LIMITS to the children in care- locked gate. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents and cleaning compounds are kept in the

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

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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Document Has Been Signed on 02/22/2023 02:42 PM - It Cannot Be Edited

Created By: Judy Laureano On 02/21/2023 at 11:22 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: LEVI FAMILY CHILD CARE	FACILITY NUMBER: 197494846
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(a)

Staffing Ratio and Capacity

(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above Licesee was observed caring for 11 children with 2 adults, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/03/2023
	Plan of Correction
1 2 3 4	Licensee was instructed to contact parents and arrange child pick-up. (5) children were picked up during the course of the inspection. Licensee will sign a declaration (LIC855) agreeing to maintianing license capacity and submit to LPA by 3/3/2023. Licensee also agreed to review https://ccld.childcarevideos.org/family-child-care-providers/how-many-children-can-attend-a-family-child-care-home/ and submit a statement to LPA that information was reviewed with staff by 3/3/2023

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:

Claudia Escobedo

LICENSING EVALUATOR NAME:

Judy Laureano

LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

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: LEVI FAMILY CHILD CARE	FACILITY NUMBER: 197494846
	VISIT DATE: 02/21/2023

NARRATIVE

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in an outside locked shed. Sharp object and knives were observed in the drawers in the kitchen-content inaccessible to the children in care- all doors that lead to the kitchen are maintained closed.

Licensee confirmed she is not available for overnight care and/or weekend care. Facility is available to care for infants.

LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Adequate heating and ventilation for safety and comfort were observed in the space. LPA did no to observe any stairs in the home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number as 818-462-3474.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.
Capacity as specified on the license was not being maintained during today’s inspection. LPA instructed licensee to contact parents and during the course of the inspection parents were picking up children.

LPA reviewed a sample of children’s file and 6 out of 6 files and files were complete. Staff files were reviewed and LPA observed missing proof of immunization LPA issued a Technical Violation for D. De Leon.

LPA discussed the LIC 311D- Records to be maintain in the facility and provided licensee with a current copy.
Pediatric CPR and First certification was reviewed, Licensee has current certification with expiration date of 12/2023. Mandated Reporter training was reviewed.
All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

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: LEVI FAMILY CHILD CARE	FACILITY NUMBER: 197494846
	VISIT DATE: 02/21/2023

NARRATIVE

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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.

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.

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.

A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Adi Levi and appeal rights were reviewed.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

LIC809 (FAS) - (06/04)

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