198022068-3-24-2026-33-CC-AEIN-DSGPCW-20260324111237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198022068
Report Date: 03/24/2026
Date Signed: 03/24/2026 11:13:08 AM

Document Has Been Signed on 03/24/2026 11:13 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	TSYRENOVA FAMILY CHILD CARE		FACILITY NUMBER:	198022068
ADMINISTRATOR/ DIRECTOR:	TSYRENOVA, VIKTORIIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(747) 215-4498
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91207
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/24/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Victoriia Tsyrenova, Licensee		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

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 03/24/26, at 8:30 AM Licensing Program Analyst (LPA) Anomeh Eivazian conducted an announced pre-licensing inspection to the above facility. LPA met with Victoriia Tsyrenova, Applicant who guided analyst on a tour of the facility. Pre-licensing Entrance Checklist (LIC9280) was provided to applicant, Victoria Tsyrenova. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. Per applicant operation hours will be Monday to Friday, 7:00 a.m. to 11:00 p.m.. Applicant states she will care for children 1-12 years old. Applicant was previously licensed at 411 Lincoln Avenue #25, Glendale, CA 91205 with facility number 198021558. Fire clearance for Large Family Child Care Home was granted on 03/10/26. All areas identified on the facility sketch were inspected. This is a two story home located on the first level. The home consists of 5 bedrooms, 3 restrooms, living room, dining room, kitchen, family room, front yard (fenced), backyard (fenced), balcony in the second floor, and detached garage. Per applicant, parents will enter the home through the main entrance which leads to the living room. Areas that are accessible to children are as follows: Bathroom in the hallway, living room, dining room, one bedroom adjacent to the main entrance and front yard (fenced). Areas off limits based on facility sketch submitted to children and parents include: Kitchen, two bedrooms in the first floor, family room, entire second floor which consists of two bedrooms, two bathrooms, balcony, backyard, and garage. Rooms that are off-limits need to be made inaccessible during operating hours REPORT CONTINUES ON NEXT PAGE 1 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: TSYRENOVA FAMILY CHILD CARE	FACILITY NUMBER: 198022068
	VISIT DATE: 03/24/2026

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The applicant does understand that licensing staff may have access to off-limit areas during inspection if necessary.

There is a in ground pool on the premises which is located in the backyard. The pool area is off-limit and not inaccessible to the children. Pool area in the backyard is separated by five feet high (60 inches) iron fencing in one side, but the gap from the ground to the bottom of the fence is 5 inches, also gates swing away from the pool, self-closing with a self-latching, key lockable devise placed no lower than 60 inches above the ground. The other side of the pool which leads to the Stocker Street is covered with at least six feet high trees with fencing, but the other two sides of the pool which is facing toward the building are not fenced. (Pictures were taken).

Also, LPA observed an alarm that was placed in the swimming pool, will sound upon detecting an entrance into the water. During this inspection, LPA asked the applicant to test the alarm. The alarm was turned on and was in working condition when applicant put her hand in the pool and LPA heard the alarm went off and heard by LPA. The alarm is compliant with ASTM International Standard F2208. A life ring with a minimum exterior of 17 inches and labeled as approved by the United Stated Coast Guard and a rescue pole with a body hook and a minimum fixed length of 12 feet were observed by LPA visible from the swimming pool and readily available for immediate use. The fence did not meets Title 22 Regulations and AB-2866 Pool Safety Legislative information at this time.

LPA also informed applicant she shall perform a daily inspection of the drawing prevention safety feature and safety equipment before opening the facility and maintain log of the inspections to be provided to the department upon request.
LPA also asked applicant to add alarms on the off-limit bedrooms doors and off-limit bedrooms windows that are facing toward the pool area.

At 8:40 am, the applicant began touring LPA’s through the home starting with the entry way which lead directly to the living room. The living room was inspected and electrical outlets were observed to be covered. LPA observed children tables, chairs and toys in the living room. There is a fireplace in the living room that was screened with child safety gates and not with fire resistance screen. Next to the living room, the dining room was inspected and LPA observed children toys and supplies in the dining room. Next LPA toured the

REPORT CONTINUES ON NEXT PAGE 2 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: TSYRENOVA FAMILY CHILD CARE	FACILITY NUMBER: 198022068
	VISIT DATE: 03/24/2026

NARRATIVE

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off-limit kitchen and observed two sliding child proof safety gates where installed to the two entrances of kitchen to make it inaccessible to the children. Next LPA toured the one bedroom adjacent to the main entrance and did not observe any hazards. Per applicant, she will use the bedroom for ill children in case if it will be needed. Next LPA toured the one bathroom in the first floor and did observe any hazards. Next LPA toured the off-limit two bedrooms in the first floor and did not observe any hazards. LPA observed plastic door knobs on the off-limit areas doors. Next LPA toured the off-limit family room and did not observe any hazards. There is a fireplace in the family room which has been blocked off to prevent access. There is a door in the off-limit family room which leads to the off-limit backyard. Windows from Family room, and two bedrooms in the first floor are facing toward the pool area. Next LPA toured the off-limit second floor which consists of two bedrooms, two bathrooms and balcony and did not observe any hazards. LPA observed a sliding child safety gate was installed to the stairs in the first floor which leads to the second floor to make the off-limit second floor inaccessible to the children. LPA observed applicant's family members personal belongings in the home during this inspection. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the kitchen. It was serviced on 08/07/2026 as read by LPA from the service tag. Applicant tested the carbon monoxide and smoke detectors in the living room. It sounded off the alarms and heard by LPA to be functional. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children.

Next LPA toured the front yard fenced. Per applicant, children will use the front yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The front yard ground is grass. Next LPA toured the off-limit backyard and observed a water fountain. Next LPA toured the off-limit garage and did not observe any hazards. LPA observed off-limit back yard is gated from the side yard to make it inaccessible to the children. The applicant states that supervision is always provided.

APPLICANT RENTS THE HOME AND HAS LANDLORD CONSENT: Because the applicant rents the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

REPORT CONTINUES ON NEXT PAGE 3 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: TSYRENOVA FAMILY CHILD CARE	FACILITY NUMBER: 198022068
	VISIT DATE: 03/24/2026

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The applicant states that she will provide food for children in care. Applicant was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated. Per applicant, at 10:00 am, there are no pets, weapons, or firearms on the premises. There are toys available for children. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. LPA advised applicant that if a child shows signs of illness he/she/they shall be separated from other children. Per applicant no one smokes in the home. There are first aid kit in the home, in the kitchen. Per applicant, she will not provide transportation.

Applicant has proof of CPR and First Aid training as indicated on the certificate. The applicant does have proof of Health and Safety training (completion date: 07/28/2024), Pediatric First Aid and CPR (ex. 08/2026). The applicant has proof of immunization against influenza, pertussis, and measles.
Applicant completed required mandated reporter training on 06/04/2024. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

The following was discussed with the applicant:
Applicant was reminded that all adults 18 and over living in the home, persons who provide 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 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.

-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.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check and batteries replaced as needed.
-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

REPORT CONTINUES ON NEXT PAGE 4 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: TSYRENOVA FAMILY CHILD CARE	FACILITY NUMBER: 198022068
	VISIT DATE: 03/24/2026

NARRATIVE

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-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
-No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
-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.
- Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

INFANT CARE: Applicant states that she will care for infants (12-24 months old). Applicant states that infants will sleep in the living room and dining room where they are constantly supervised. LPA advised the Applicant that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Applicant.

SAFE SLEEP: 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.

REPORT CONTINUES ON NEXT PAGE 5 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

LIC809 (FAS) - (06/04)

Page: 6 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: TSYRENOVA FAMILY CHILD CARE	FACILITY NUMBER: 198022068
	VISIT DATE: 03/24/2026

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Medication: 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

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

Per applicant, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) will be on children’s files. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.

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.

Megan’s Law - Family Child Care Homes On this date, 02/12/2026, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

REPORT CONTINUES ON NEXT PAGE 6 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

LIC809 (FAS) - (06/04)

Page: 7 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: TSYRENOVA FAMILY CHILD CARE	FACILITY NUMBER: 198022068
	VISIT DATE: 03/24/2026

NARRATIVE

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MyChildCarePlan.org--Child Care Centers and Family Child Care Home Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

The following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 04/24/26:

1. Applicant will make the pool fencing in compliance with Title 22 Regulations requirements.
2. Applicant will add door alarm on the family room door and windows which are facing toward the pool area.
3. Applicant will fill the water fountain in the backyard with soil or rock to make it safe for children.
4. Applicant will screen the fireplace in the living room with fire resistance screen to be safe for children.

A large family child care license will be granted upon receipt of proof of corrections for the above. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Exit interview conducted and report was reviewed with the applicant, Victoriia Tsyrenova.

REPORT END 7 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

LIC809 (FAS) - (06/04)

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