197405238-7-7-2022-30-CC-DWHE-CG4PGR-20220707111847

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197405238
Report Date: 07/07/2022
Date Signed: 07/07/2022 11:18:59 AM

Document Has Been Signed on 07/07/2022 11:18 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	SAMAD FAMILY CHILD CARE		FACILITY NUMBER:	197405238
ADMINISTRATOR:	RANA SAMAD		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 545-1824
CITY:	MANHATTAN BEACH	STATE: CA	ZIP CODE:	90266
CAPACITY:	14	CENSUS: 1	DATE:	07/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	Samad Rana		TIME COMPLETED:	11:45 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) Doris Whitmore met with licensee, Rana Samad, who guided analyst on a tour of the home for an unannounced Annual Required Inspection visit. Upon arrival LPA Whitmore observed 1 infant in care. This is a 2 story, 5-bedroom, 4-bathroom home with kitchen/dining, living room, and converted garage. The downstairs has 1 bedroom that is utilized as a guest bedroom / napping area only. Licensee has a converted garage used as a day care activity room. LPA observed 1-bathroom downstairs. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include licensee, husband and 3 adult children. Licensee has 1 cat that is away from the children in care. The following areas are used for daycare. Main care is provided in the converted garage/activity room. LPA observed age appropriate furniture, games and activities. No hazards were observed in main care area. Children use the bathroom located next to main care room. Off limit areas include the home's entire upstairs, all bedrooms and kitchen. The home has a fireplace that has a barricade. The kitchen and bathroom areas were inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects. All items were made inaccessible to children. Kitchen/bathroom drawers do have latches. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink with latch), and hazardous items (sharp knives in upper kitchen cabinet) that can pose a danger to children. LPA observed access to backyard from main care room. LPA observed age appropriate toys, and activities for children in care. All plants, trees and shrubs are maintained neat and clean. Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. There are age appropriate toys and napping equipment on the premises. Children nap in playpens and on cots. The required fire extinguisher (2A10BC), carbon monoxide and smoke detectors are in operable condition. Home has central AC and heat. CPR/First Aid expires September 18, 2023. Licensee will take the Preventative Health and Safety Training and send the coy of the Certificate. The Mandated Reporter Training Expired April 12, 2022.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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

FACILITY NAME: SAMAD FAMILY CHILD CARE	FACILITY NUMBER: 197405238
	VISIT DATE: 07/07/2022

NARRATIVE

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Licensee will take the Training and send in a copy of the certificate. Licensee will also send an updated Immunization Record that specifies the TDAP and TB Test. The First Aid kit was observed and is complete. Licensee has posted as required the License, Emergency Disaster plan, and Parents Rights Poster, Earthquake Preparedness.

The following was discussed with the licensee:

Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were discussed. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov . Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home 7 days a week, 24 hours a day

Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1^st offense and up to $3000.00 for the 2^nd offense within a 12-month period. The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B.

The licensee was advised that 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, 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. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).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. The ADA requires that child care providers not discriminate against persons with disabilities on the basis of disability, that is, that they provide children and parents with disabilities with an equal opportunity to participate in the child care center's programs and services.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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

FACILITY NAME: SAMAD FAMILY CHILD CARE	FACILITY NUMBER: 197405238
	VISIT DATE: 07/07/2022

NARRATIVE

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The licensee was informed 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 child care 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

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

State law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. 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. Only children eating may be in highchairs and that car seats are utilized only for transportation.

AB 1207: Beginning on January 1, 2018, this law 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. Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

The facility was in compliance Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited A copy of this report, and a Notice of Site Visit and Appeal Rights were issued and explained to the licensee. An exit interview was conducted.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

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