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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413303
Report Date: 01/29/2020
Date Signed: 01/29/2020 12:39:35 PM

COMPREHENSIVE INSPECTION
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:KAIHANI FAMILY CHILD CAREFACILITY NUMBER:
197413303
ADMINISTRATOR:KAIHANI, FARIDEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 641-8370
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY:12CENSUS: 8DATE:
01/29/2020
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Farideh Kaihani - LicenseeTIME COMPLETED:
01:00 PM
NARRATIVE
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On 1/29/2020, Licensing Program Analyst (LPA) Helen Estrella and Lisa Rios conducted an unannounced visit to the family child care home for the purpose of a annual/required inspection. Upon arrival, LPA met with the licensee Farideh Kaihani and assistant. The licensee was informed of the nature of the visit. There were 8 children (3 infants and 5 children) present during the inspection. LPA's were guided on a tour of the home inside and outside).

The home is a one story 3-bedroom, 2-bathroom that includes living room, dining room, kitchen, family room in the rear of the home, front yard, back yard, garage that has been converted as a "classroom" and includes 1 restroom, rear storage unit, rear utility shed and enclosed garden coop. The accessible areas are: Room #2, Room #3, family room, living room, dining room, kitchen, back yard, and rear garage (classroom). The off limits areas are: Room #1 that is the licensee's office, front yard, rear utility shed, and rear storage room.

LPA's observed Fire extinguisher size 2A10BC that requires service, operable smoke and carbon monoxide detectors, age appropriate toys and equipment, changing table in family room. napping equipment, and equipped first aid kit. The licensee did not have latches in the kitchen for drawers with sharp objects such as scissors and knife. LPA's observed can of Raid in lower sink cabinet without a latch, accessible to children in care. LPA's observed kitchen drawers with sharp rawers that require latches. LPA's observed that licensee has First Aid/Pediatric certification valid through 1/8/21.
(Page 1)
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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 8
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: KAIHANI FAMILY CHILD CARE
FACILITY NUMBER: 197413303
VISIT DATE: 01/29/2020
NARRATIVE
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During the inspection, LPA's observed an infant sleeping in a car seat in room #1 with the door closed. LPA's inspected Room #2 with door slightly closed and observe there were 3 play pens. Play pen #1 was observed with a pillow, a pacifier and blanket inside the play pen. Play pen #2 was observed with a child's nap sack and blanket. Play pen #3 was observe with sleeping child. Each play pen had blanket hanging over the side of the rail. LPA's consulted safe sleep practices with the licensee. The licensee immediately removed all blankets and pillows from each play pen. LPA's observed an infant in a baby bouncer, baby swing and baby bounce jumper in the living room, and a baby walker and baby bouncer in the children's "classroom" (the rear garage that is used as the children's activity room).

LPA's inspected outdoor area. The area was observe free of debris. LPA's inspected the garage, that has been converted as a classroom for children's activities. The licensee is informed that no eating or sleeping is to be conducted in the classroom. LPA's observed enclosed garden with a mandarin tree, lemon tree, herbs that were out of reach of children. LPA's observed enclosed chicken coop with 5 chickens outside of reach of children.

LPA's reviewed children's records and files are missing immunization records. The licensee did not have the assistant's file. The assistant stated she started working as of 1/28/20. LPA did not observe completed Mandated Reporter training for the licensee and assistant. LPA's observed licensee operating within capacity limits of licensee and licensee states currently does not have any children in care at this time that require Incidental Medical Services (IMS). There are NO bodies of water in the premises.

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.
(Page 2)
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 2 of 8
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: KAIHANI FAMILY CHILD CARE
FACILITY NUMBER: 197413303
VISIT DATE: 01/29/2020
NARRATIVE
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The following was 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.

The licensee is made aware 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. Phone number: (916) 654-1541. Email Address: childcareadvocatesprogram@dss.ca.gov

The licensee is informed that a current roster of children enrolled must be available and maintained for a period of 3 years, even after children no longer are attending the facility. Fire and safety drills must be performed every month and documented for review by the Department.

The licensee is informed of reporting requirements and that any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing to the Department.

The licensee is advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation.

Licensee was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Licensee is reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.
(Page 3)
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: KAIHANI FAMILY CHILD CARE
FACILITY NUMBER: 197413303
VISIT DATE: 01/29/2020
NARRATIVE
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The licensee is informed of safe sleeping practices for infants to prevent S.I.D.S. (Suddent Infant Death Syndrome). The applicant is informed that infants are always to be placed on their backs for sleeping; to use tight-fitting sheets on the crib or play yard mattress; do not hang any items on or above the crib; to keep all items out of the crib/play yard; infants are not to be swaddled or have items covering them while sleeping; and 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. 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 informed that a 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. The applicant was made aware that a licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

LPA discussed AB633 and informed licensee that, upon receipt of a Type A deficiency, the licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

The facility did not appear to operate within substantial compliance. Type A and B deficiencies were cited during today's inspection. LPA was provided copies of the following: Safe Sleep Practices, (LIC 508) Criminal Record Statement and (LIC 9182) Criminal Record Transfer Request forms.

A copy of this report, a Notice of Site Visit and appeal rights were provided to the licensee. An exit interview conducted.
(Page 4).
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: KAIHANI FAMILY CHILD CARE
FACILITY NUMBER: 197413303
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/30/2020
Section Cited

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Operation of a Family Child Care Home. A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c).
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This requirement is not met as evidenced by LPA's observed a baby swing, 2 exersaucers, 2 baby bouncer at the faciity.
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Health & Safety Code regulation no later than 1/31/2020.
Type A
01/30/2020
Section Cited

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Personal Rights: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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This requirement is not met as evidenced by LPA observe infant sleeping inside car seat with door closed and infant sleeping in Room #2 unspervised
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at all times.
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: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: KAIHANI FAMILY CHILD CARE
FACILITY NUMBER: 197413303
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/30/2020
Section Cited

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Operation of Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger ... hall be stored where they are inaccessible to children.
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This requirement is not met as evidened by LPA'a observed can of Raid under sink accessible to children in care.
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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: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: KAIHANI FAMILY CHILD CARE
FACILITY NUMBER: 197413303
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/12/2020
Section Cited

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Employee/Volunteer Immunizations: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he/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.
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This requirement is not met as evidenced by the licensee did not hace employee records and proof of immunizations
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Type B
02/12/2020
Section Cited

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Immunization. Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
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This requirement is not met as evidenced by LPA's did not observe proof of immunizations for all children enrolled at the facility.
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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: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: KAIHANI FAMILY CHILD CARE
FACILITY NUMBER: 197413303
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2020
Section Cited

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Mandated Reporter. The department shall issue a notice of deficiency at the time of a site visit to the licensee of a licensed child day care facility who is not in compliance with this section. The licensee shall, at the time the department issues the notice of deficiency, develop a plan to correct the deficiency within 45 days.
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This requirement is not met as evidenced by the licensee did not have completed the training nor proof of completion.
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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: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 8 of 8