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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197406708
Report Date: 07/09/2024
Date Signed: 07/09/2024 01:41:58 PM


Document Has Been Signed on 07/09/2024 01:41 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:NAEIM FAMILY CHILD CAREFACILITY NUMBER:
197406708
ADMINISTRATOR:NAEIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 307-9479
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:14CENSUS: 14DATE:
07/09/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Eris Naeim, LicenseeTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required 3-Year Annual Inspection on this date. LPA met with Eris Naeim, Licensee, explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. The license provided tour of the home LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee the hours of operation are Monday-Friday 8:30am - 4:00pm. LPA observed 14 preschool aged children present. The facility is over the capacity of licence, posing an immediate risk to the health and safety of children in care. Also present was Liliana Perez Ordonez, Assistant and Martha Ixcoy, Volunteer. Individuals residing in the home were discussed and noted. All adults required to complete a background clearance working and/or residing in the home have done so. Per licensee, volunteers working with children are always supervised by a qualified provider.

This is a two story home. The daycare area is located in the family room to the right of the stairs upon entry. The parents drop off at the side of home and entrance to the daycare room. LPA observed the required postings at the parent drop off area.

Other areas accessible to children is kitchenette and bathroom in daycare area, the backyard used for outdoor play (enclosed).

Off limit areas are: Entire second floor, main level, attached garage. Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. Rooms that are off-limits need to be made inaccessible during operating hours. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA reviewed facility forms and forms that are required to be posted. LPA provided an updated Publication (PUB) 394- Notification of Parent Rights, LIC 610- Facility Disaster Plan and Licensing Form and (LIC) 9148- Earthquake Preparedness. LPA reviewed the LIC 9040- Facility Roster and that is not updated with current children in care - Page 1 – Report Continues

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
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 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NAEIM FAMILY CHILD CARE
FACILITY NUMBER: 197406708
VISIT DATE: 07/09/2024
NARRATIVE
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Smoke and carbon monoxide detectors in the daycare room were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 10/19/23, Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone line. The home is observed to be clean and orderly. There are toys and other age-appropriate material available. LPA observed that cleaning compounds are in kitchen inaccessible to children in care. The bathroom used by children is observed to be clean and free of hazards.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Per Licensee there are no firearms or weapons stored in the home

Isolation area for sick children waiting to be picked up is in the daycare room, supervised and away from the other children.

The Licensee is currently not providing care for Infants. LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Children are using the back yard for outdoor play. 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 including a two level wooded and plastic play structure, and swing set which is anchored to the ground with cushioned material under structure. LPA did not observe any objects that could be hazardous to children in care. The facility does not have a pool or similar bodies of water. LPA observed a large dog in the home. Per licensee, the dog is kept in the home and is allowed in daycare area with children present, extra supervision was advised. Per licensee, the backyard is scanned prior to children being taken out to make sure there are no hazards including dog poop.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months)


-------------------Page 2 – Report Continues
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NAEIM FAMILY CHILD CARE
FACILITY NUMBER: 197406708
VISIT DATE: 07/09/2024
NARRATIVE
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Staff records were reviewed Licensee and staff were missing current Mandated Reporter Training Certificate AB1207 posing a potential risk to the health and safety of children in care. LPA provided a copy of LIC 279 and 279B to be updated and sent to the Regional Office. LPA provided printout of Capacity Regulation for Large FCC.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

Licensee was informed of the MyChildCarePlan.org website; 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 provided Child Care Advocate information.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on the LPA's observations and records review the facility is cited 1 "A" and 2 "B" deficiencies in accordance with California Title 22 Regulations. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form LIC9224 during this visit. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Eris Naeim, Appeal Rights were discussed and a copy provided.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 07/09/2024 01:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: NAEIM FAMILY CHILD CARE
FACILITY NUMBER: 197406708

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that there were 14 children present between the ages of 2years and 4 years, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2024
Plan of Correction
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Per licensee, the 2, the capacity limitations will be followed and the children's schedule will be adjusted so that there are only 12 pre schoolers in care at all times. The license will provide a written schedule and updated Roster vial email by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 07/09/2024 01:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: NAEIM FAMILY CHILD CARE
FACILITY NUMBER: 197406708

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in Licensee and Staff #1 did not have a current Mandated Reporter Training Certificarte which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2024
Plan of Correction
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Per licensee the Mandater Reporter Training AB1207 will be completed and a copy of the certificate will be sent to LPA by POC Due date.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that the Facility Children's Roster was not updated with the current children's information which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2024
Plan of Correction
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Per licensee the Facility Rostar LIC9040 will be completed and a copy will be sent to LPA by POC Due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5