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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495294
Report Date: 12/03/2024
Date Signed: 12/03/2024 05:15:23 PM

Document Has Been Signed on 12/03/2024 05:15 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:KUZINA FAMILY CHILD CAREFACILITY NUMBER:
197495294
ADMINISTRATOR/
DIRECTOR:		VIKTORIIA KUZINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(267) 261-2560
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
12/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Viktoriia KuzinaTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On December 3, 2024, Licensing Program Analyst (LPA), Veronica Wheatley conducted an Annual inspection and met with licensee Viktoriia Kuzina. LPA entered the front door however the parents drop the children off on the side of the house. Days and hours of operation are currently Monday through Friday 8am to 6pm. LPA observed 12 children napping on cots. The children were supervised by the assistant.

LPA toured the areas of the day and the outside backyard. Current facility sketch confirmed that the rear bedroom is used for the day care room. The children use the bathroom inside of the room. The other bedrooms, bathroom, living room and kitchen are off limits. LPA observed a child proof gate at the entrance of the kitchen. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There is a working fire extinguisher, smoke detector and carbon monoxide detector. The home has adequate heating and ventilation (central heat and air conditioning) for safety and comfort. LPA observed napping cots, sheets and blankets. There are no stairs in the home. LPA observed several age appropriate toys. The home has working telephone service and LPA confirmed the phone number. LPA observed first aid kit and thermometer.

LPA discussed Safe Sleep Regulations with licensee. Cribs and play yards will be 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 up to 2 years old 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. There is one infant child present today.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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 2
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: KUZINA FAMILY CHILD CARE
FACILITY NUMBER: 197495294
VISIT DATE: 12/03/2024
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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. Licensee states she does not transport children.

LPA inspected the backyard for outdoor play and safety. LPA observed several age appropriate toys. There are no bodies of water and no pets on the premises. The garage is off-limits and will remain closed during day care hours.

LPA reviewed a sample of children’s forms. All other required forms are posted on the parent board. Licensee's Mandated Reporter Training expires 3/2025. Licensee’s pediatric CPR/First Aid expires on 3/2025. Licensee has required Health & Safety certification. Licensee understands that all employees and/or volunteers must have immunization records on file for influenza, pertussis and MMR. LPA reviewed new employee (assistant) file and all required documents are in the file.

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. Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA discussed with the licensee the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training (Mandatedreporterca.com), Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

Exit interview conducted. Report was read and signed. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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