197404620-2-13-2020-30-CC-KSCT-BLRPZ6-20200213104502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197404620
Report Date: 02/13/2020
Date Signed: 02/13/2020 10:45:30 AM

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:	MUHAMMAD FAMILY CHILD CARE		FACILITY NUMBER:	197404620
ADMINISTRATOR:	MUHAMMAD, TONYA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 679-3398
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	14	CENSUS: 7	DATE:	02/13/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Tonya Muhammad		TIME COMPLETED:	11:00 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

Licensing Program Analyst (LPA), Keyona Scott, conducted an unannounced Annual Inspection to ensure the health and safety of the Child Care Home according to Department Regulations and Health and Safety Codes. LPA met with Licensee, Tonya Muhammad, on 02/13/2020. Licensee, Licensee's Assistant (Adult 1) and seven children, which includes two infants, were present during the inspection. All Adults present, residing and working in the home are fingerprint cleared and associated to the facility. LPA was guided on a tour inside and outside of the home at 8:50 AM.

The home is a one story, three bedroom, two bathroom home with a living room, dining room, and kitchen. The off-limit areas of the home are the master bedroom, master bathroom and the middle bedroom, located at the rear of the home. The master bedroom and middle bedroom are made inaccessible by closed door during operation hours. The primary child care area of the home is in the living room area, located at the entrance of the home. The children also utilize the bedroom at the entrance of the hallway. The bedroom is used as an additional activity room. The garage has been converted into a playroom. LPA observed toys, books and a bathroom in the playroom. Per Licensee, no napping or eating takes place in the playroom. The children utilize the bathroom that is in the playroom and also the bathroom, in the home, at the rear of the hallway. The kitchen is utilized as an eating area. LPA observed a small children table and bench set in the kitchen area. LPA observed screened wall heater in the living room at the hallway entrance. LPA also observed screened fireplace in the living room area.

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Home utilizes ceiling fan and portable fan as cooling sources and screened wall heater as a heating source. LPA observed portable heater in the playroom area. Home has a working telephone. Hazardous materials in the kitchen and bathroom are inaccessible to children. According to the Licensee, there are no weapons or firearms at the home; None were observed by LPA. Per Licensee, there are no pets in the home; None were observed by LPA.

Page 1

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020

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 5

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: MUHAMMAD FAMILY CHILD CARE	FACILITY NUMBER: 197404620
	VISIT DATE: 02/13/2020

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

The home is equipped with a fully charged fire extinguisher which is at least a 2A:10BC. The home is also equipped with a working dual smoke detector and carbon monoxide detector. There is also a first aid kit equipped in the home. LPA observed Licensee's and Assistant's First Aid and CPR certificates with an expiration dates of 04/19/2020 (Licensee) and 05/11/2021 (Assistant). Licensee and Assistant also completed Mandated Reporter training on 03/26/2018 (Licensee) and 10/11/2019 (Assistant). LPA observed required postings posted. Licensee and Assistant completed Health, Safety, and Nutrition training on 11/06/2016 (Licensee) and 01/12/2020 (Assistant).

Toys and playthings are safe, orderly and age-appropriate for the children. Licensee agrees that no baby-walkers, bouncers, jumpers, exersaucers and similar items will be used for children in care and are kept inaccessible; None were observed by LPA.

Outside play is conducted in the backyard. The outdoor play area is fully fenced in and also is free from defects or dangerous conditions. LPA observed two separate fenced play areas with kitchen playsets and other variety of toys. No pools, spas, hot tubs, fish ponds, or similar bodies of waters observed during the inspection.

LPA observed current Fire Disaster Drill log. Licensee has conducted fire disaster drills at least once a month as required.

LPA observed current Child Care Facility Roster of the children enrolled. There are currently ten children enrolled at the facility.

The facility operation hours are Monday through Friday, 24 hours. Per Licensee, does not currently have evening care children but hours are open for evening care if needed.

Page 2

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: MUHAMMAD FAMILY CHILD CARE	FACILITY NUMBER: 197404620
	VISIT DATE: 02/13/2020

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

Licensee states is not providing IMS (Incidental Medical Services) services at this time.
Update on Incidental Medical Services: 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
Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

The following was thoroughly discussed with the Licensee:

All adults living and working in the home must be fingerprinted and cleared prior to entering the facility. The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.

Licensee was reminded it is the Licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000. Also call the CCL office within 24 hours of the Unusual Incident and follow up with a written Unusual Incident/Injury Report (LIC 624B) within 7 business days.

Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete General and Child Care Mandated Reporter 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. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/.

Page 3

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MUHAMMAD FAMILY CHILD CARE	FACILITY NUMBER: 197404620
	VISIT DATE: 02/13/2020

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

Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome

The licensee was also recommended the following Safe Sleep Practices: always place infants on their backs for sleeping; use only a tight-fitting sheet on the crib or play yard mattress; do not hang any items from the crib or above the crib; keep all items, including blankets, out of the crib or play yard; pacifiers may be used as long as they do not have items attached to them; infants should not be swaddled or have any items covering them while sleeping; the temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold. Please note, these guidelines are recommendations for best practices only, until regulations are approved and adopted.

Licensee was provided the following forms/brochures:

PUB 394: Notification of Parents' Rights
PIN 19-02-CCP: Safe Sleep Awareness Campaign
NIH Pub. No. 18-HD-5759: What Does A Safe Sleep Environment Look Like?
A Child Care Provider's Guide to Safe Sleep
Safe Sleep in Child Care
PUB 271: Preventing Shaken Baby Syndrome/Abusive Head Trauma
PIN 19-10-CCP U.S. Consumer Product Safety... Fisher-Price Infant Equipment Accessory Recall
PIN 19-12-CCP U.S. Cosumer Product Safety... Infant Sleeper Recall
Effects of Lead Exposure
PIN 19-09-CCLD Division Mailchimp Account Information... Subscribe For Updates
SafeBaby2indd- Safe Sleep

The licensee was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.

Page 4

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: MUHAMMAD FAMILY CHILD CARE	FACILITY NUMBER: 197404620
	VISIT DATE: 02/13/2020

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

The facility was operating in substantial compliance during this inspection on 02/13/2020. There were no Title 22 Deficiencies cited.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

An exit interview was conducted, and a copy of this report (LIC 809), Notice of Site Visit, along with appeal rights were given to Licensee, Tonya Muhammad, whose signature confirms today's inspection and report.

Page 5

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

LIC809 (FAS) - (06/04)

Page: 5 of 5