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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494846
Report Date: 02/21/2023
Date Signed: 02/22/2023 02:40:46 PM

Document Has Been Signed on 02/22/2023 02:40 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 CAREFACILITY NUMBER:
197494846
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 11DATE:
02/21/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Adi LeviTIME COMPLETED:
02:00 PM
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On 2/21/2023 Licensing Program Analyst (LPA) Judy Laureano conducted an announced inspection with Adi Levi for the purpose of an increase of capacity inspection for 6650 Melvin Avenue, Reseda, CA 91335. The purpose of this increase of capacity visit is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.
Present during today's inspection was Licensee, Assistant and Licensee's husband was present.

The licensee is applying for an increase of capacity; Large Family Child Care Home license for a max capacity of 14. LPA received approved fire clearance granted on 1/20/2023 by inspector Cindy Struck.

The capacity of the Large Family Child Care Home is 14. Per the application, at this time, the ages the applicant wishes to provide services for are children birth- 0 month to 5 years old with the hours of operations from Monday-Thursday 8:30 am to 4:00 p.m. and Friday 8:30 am to 3:00 p.m. Licensee was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.

Facility is a single family home with a day care room and ½ bathroom, guest room/office, bedroom 1, bedroom 2, full bathroom, dining room, kitchen, living room with a sliding door that leads to a sectioned off backyard. Licensee confirmed that children will only use the day care room and ½ bathroom and enclosed front yard and side yard.

Parents enter the home through a main gate and enter directly to the day care room. LPA observed age appropriate toys, children size tables and chairs. Parent board was observed as soon as you enter. LPA observed children’s size cubbies, wood blocks and a variety of children’s books.
The bathroom that children will use is located next to the daycare room. LPA observed and inspected the sink, under the sink cabinet the toilet and medicine cabinet. LPA discussed COVID-19 recommendation such as using paper towels and displaying a handwashing sign for children to view.
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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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
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LPA observed licensee test carbon monoxide and smoke detector in the space. LPA observed additional smoke detectors and carbon monoxide in the living room area. Fire extinguishers were observed in the kitchen area and office/guest room that is next to the daycare room.

The following areas have been designated as OFF LIMITS. The guestroom/office, bedroom 1, full bathroom, bedroom 2, living room, dining room and kitchen. The home does have a barricaded fire place in the OFF LIMITS dining room area. LPA observed all doors closed and reminded licensee to ensure doors to the OFF LIMITS areas remind closed and locked during hours of operations. Licensee confirmed that the home’s front door is not used by daycare.

The kitchen, stove and refrigerator was observed and inspected. Applicant confirmed facility will be providing meals and snacks. Sink and counter space area were observed and inspected. Knives and sharp object were observed to be made inaccessible to the children in care- area is off limits. LPA discuss food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date.

LPA observed the outdoor space- area is covered with artificial turf. LPA observed age appropriate toys such as children's card and plastic play houses. The side of the home is also used for outdoor space, the area is cemented, and a variety of outdoor toys were observed.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises.

The following areas are OFF LIMITS:
1. Guest Bedroom/office, Bedroom 1 and Bedroom 2, Full bathroom, Dining room, kitchen area, living room and enclosed backyard- sectioned off for personal use.

No corrections were observed during today’s inspections. Exit interview was conducted with applicant Adi Levi. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.
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
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The following was discussed with the applicant:
Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, family forms/records, and information to be posted.

Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.

Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation.



Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.
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)
Page: 3 of 5
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
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Applicant was also informed that the provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.

LPA discussed the safe sleep regulations with applicant 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 applicant 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 Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

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
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• Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed.
• In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
• A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
• Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)
• The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.
• Changes should be reported the to the Department as soon as they occur such as construction and remodeling, telephone number changes and/or if you move from home.
• Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference.
• Fire and safety drills must be performed every six months and documented for review by the Department.
• All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
• LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov
• Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
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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