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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413303
Report Date: 01/30/2020
Date Signed: 01/30/2020 12:45:33 PM

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:
01/30/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Farideh Kaihani - LicenseeTIME COMPLETED:
11:53 AM
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On 1/30/2020, Licensing Program Analyst (LPA) Helen Estrella conducted an unannounced Plan of Correction (POC) visit to the family child care home. Upon arrival, LPA met with the licensee and informed the nature of the visit. There were 8 children present with the licensee and Adult #1. LPA took a tour of the facility (inside and outside).

LPA observed the following during the visit:
LPA observe that exer-saucers, swing and baby walker that was observed inside the premises on 1/29/2020, were folded and taken to the back yard, in an area that is not accessible to children in care.

LPA observe child's car seat outside the Room #2 and stored, inaccessible to children. LPA observe there were no children's blankets and pillows in play pen and all doors remain open for active visual supervision at all times.

LPA observe the licensee remove disinfectants, toxins and chemicals from kitchen cabinet making items inaccessible to children in care.

LPA reviewed and obtained assistant file documents. Forms appear complete with required CCLD documents.

LPA obtained licensee declaration. The facility is pending 1 POC that is due on 2/12/2020 and 1 POC due on 3/13/2020. A copy of this report, Notice of Site Visit were provided to the licensee. Exit interview was conducted.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020
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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