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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408641
Report Date: 02/03/2022
Date Signed: 02/03/2022 05:10:39 PM


Document Has Been Signed on 02/03/2022 05:10 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:BAYBORDI FAMILY CHILD CAREFACILITY NUMBER:
197408641
ADMINISTRATOR:HOMA BAYBORDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 224-4916
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY:14CENSUS: 11DATE:
02/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH: Homa Baybordi, Licensee TIME COMPLETED:
05:00 PM
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On 02/03/2022 at 11:00 a.m. Licensing Program Analyst (LPA), conducted an unannounced Annual Required Inspection and was met by Facility Representative Staff #1. Licensee Homa Baybordi arrived at 11:27 a.m. Days and hours of operation are Monday – Friday 7:30 a.m. – 4:30 p.m.

LPA toured the home inside and outside and a census was taken. LPA Lowe requested facility to provided an updated facility sketch. Licensee confirmed that the kitchen, dining room, bathroom in child play room, living room, child care room and one bedroom are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of doors. Swimming pool is fenced per regulation. The pool gate was observed with a self-latching, self-closing gate and opens away from the swimming pool. At 11:15 a.m. LPA observed pool gate was unlocked and the self-latching system in need of repair. Licensee had pool gate repaired during visit, LPA observed repair of self-latching system. At 1:00 p.m. LPA Lowe observed the pool gate with self-latching, self-closing gate to close and lock properly. No windows or doors have direct access to the pool area. There are no firearms or ammunition on the premises. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

The fireplace located in the living room is made inaccessible by a screen and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Facility has one step from entrance way into living room, no other stairs observed in the facility. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 224-4916.

LPA Lowe observed 4 infants in care. LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care. LPA advised cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: BAYBORDI FAMILY CHILD CARE
FACILITY NUMBER: 197408641
VISIT DATE: 02/03/2022
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yard. LPA observed a light blanket in a play yard, play yard was not in use and no infants were observed in a play yard. Infants are not swaddled while in care. No infants 12 months and under are currently enrolled in the Home Child Care. LPA Lowe advised provider shall physically check on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. LPA advised there shall be an Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area is on the side yard is fenced and there are no hazards to children present within the gated play area. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was not observed completed. Licensee’s pediatric CPR/First Aid expires on 07/2022. A review of records indicates that all employees and/or volunteers do not have immunization records on file for influenza, pertussis, TB and measles.

At 11:00 a.m. LPA Lowe observed Staff #2 with a background clearance still in process. LPA Lowe advised employee shall not be present in home child care until background check has completed. Licensee sent Staff #2 home during visit. LPA advised all adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.


LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
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: BAYBORDI FAMILY CHILD CARE
FACILITY NUMBER: 197408641
VISIT DATE: 02/03/2022
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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/process.

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.

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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

LPA Deborah Lowe informed licensee Homa Baybordi that this report dated 02/03/2022 documents 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Deborah Lowe informed the licensee Homa Baybordi to provide a copy of this licensing report dated 02/03/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Homa Baybordi.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/03/2022 05:10 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: BAYBORDI FAMILY CHILD CARE
FACILITY NUMBER: 197408641

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. (A)Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in pool gate was left unlocked and self latching lock was in need of repair which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/04/2022
Plan of Correction
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Licensee called for repair of self latching pool gate to be completed. LPA Lowe observed gate being repaired during visit. LPA observed self latching pool gate to lock at end of repair. Licensee provided LPA with a declaration of understanding the pool area will remain locked at all times. Licensee added additional lock to gate. Licensee will provide a daily log to show pool gate is checked 2 times a day to ensure locked and inacessable to children. Licensee will provide log via email to LPA on or before 2/04/2022.

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: Karren StarksTELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2022
LIC809 (FAS) - (06/04)
Page: 8 of 9


Document Has Been Signed on 02/03/2022 05:10 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: BAYBORDI FAMILY CHILD CARE
FACILITY NUMBER: 197408641

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2022

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 interview and record review, the licensee did not comply with the section cited above in licensee, staff #1, and staff #2 do not have a completed Mandated Reporter Training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2022
Plan of Correction
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Licensee, Staff #1, and Staff #2 will complete the Mandated Reporter training. Licensee will email LPA Lowe with the certificate of completion. Training found at mandatedreporterca.gov
Type B
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in Staff #2 criminal background clearance is showing in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2022
Plan of Correction
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Licensee sent Staff #2 to complete a new Live Scan. Licensee advised Staff #2 to not return to home day care until licnesee verifies background clearance has been completed. Licensee will email LPA Staff #2 verification of Live Scan completed.

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: Karren StarksTELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2022
LIC809 (FAS) - (06/04)
Page: 9 of 9


Document Has Been Signed on 02/16/2022 09:24 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/04/2022 11:02 AM

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: BAYBORDI FAMILY CHILD CARE
FACILITY NUMBER: 197408641

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Personnel Requirements
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in Licensee does not have verification of MMR vaccine, Staff #1 and Staff #2 do not have verification of MMR, DTap, Flu, and TB which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2022
Plan of Correction
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Licensee to email LPA verification/ proof of Staff #1 and Staff #2 verification proof of MMR, DTap, TB, and Flu vaccine on or before 2/18/2022.

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: Karren StarksTELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2022
LIC809 (FAS) - (06/04)
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