Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415775
Report Date: 01/13/2016
Date Signed 01/13/2016 02:13:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:LEVY FAMILY CHILD CAREFACILITY NUMBER:
197415775
ADMINISTRATOR:LEVY, MAGIE (MARGALIT)FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 284-9982
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:14CENSUS: 12DATE:
01/13/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Magie LevyTIME COMPLETED:
02:15 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
Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit . LPA met with the licensee and toured the home inside and outside. LPA observed 12 napping children ( one infant). The licensee's home is a single story 2 bedroom, 2 bathroom, living room, dining room, kitchen, laundry room and playroom dining room, and rear 2 rooms, indicated as "Day Care" on the facility sketch, for the children. Parents and children enter through the gate that leads directly into the back yard and the playrooms are accessible from a rear door. The children's bathroom is accessible from the upper play room. The remainder of the home is only accessible through the kitchen. Licensee keeps the door closed and now has a safety device on the knob to prevent unsupervised access. The home's 3 bedroom's and 1 additional bathroom are off-limits. The off-limits bathroom is made inaccessible by a hook style latch on the door. There is a garage located in the back yard on the right side which will not be used for any child care activities. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include Licensee, licensee's spouse and 2 children. Licensee has an assistant ( cleared and associated to the facility).
The home was found to be clean and orderly with proper ventilation for safety and comfort. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. The kitchen cabinets and drawers were inspected for inaccessibility of toxins/chemicals, knives and other sharp objects which may be harmful to children in care. The Fire Extinguisher (2A-10-BC) is mounted on the wall in the kitchen. There is a working smoke/carbon monoxide detector located in the play room. Licensee has current CPR or First Aid. Current CPR and First Aid taken 12/2014 expire 12/16. The First Aid kit was observed, and complete.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2016
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: LEVY FAMILY CHILD CARE
FACILITY NUMBER: 197415775
VISIT DATE: 01/13/2016
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
26
27
28
29
30
31
32
LPA observed toys and furniture that were age appropriate and in good repair.
LPA toured the backyard and found it to be fully fenced. The right section of the back yard is fenced and children are not allowed in this area. LPA observed several bicycles for use on the cemented area. There are several slides on the carpeted area and a swing set that contains 3 swings and a slide. The swing set was securely mounted. The entire back yard is enclosed. Children will eat either outside on tables in the back yard or inside the play room.

Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , Child Care Facility Roster (LIC9040), Emergency Disaster Plan (LIC610a).

A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card.

"Incidental Medical Services were discussed". Per licensee incidental medical services are not and will not be provided.

Exit interview was conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2016
LIC809 (FAS) - (06/04)
Page: 2 of 2