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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 05:09:51 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: 9DATE:
01/30/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Farideh Kaihani - LicenseeTIME COMPLETED:
01:15 PM
NARRATIVE
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On 1/30/2020 at 11:15 AM, Licensing Program Analyst (LPA) Helen Estrella conducted an unannounced case management inspection for the purpose of deficiencies observed during a Plan of Correction (POC) visit conducted on 1/30/2020. LPA observed children present with the licensee and Adult #1. At 12:29 PM, licensee's assistant arrived to the facility with 1 child.

The following deficiency was observed during today's visit:
At 11:19 AM, LPA observed Adult #1 exit family room with purse and jacket on hand running out of the facility through the side yard gate.

LPA observed out of the 9 children present, 7 children were eating in the dining area. Adult #1 was observed outside of the family room, with purse and jacket on hand and running out of the premises through the side gate. The licensee stated Adult #1 was only present at the facility to 'help out' but was already leaving and then stated that Adult #1 went to use the restroom in the back. LPA confirmed with the licensee that Adult #1 was assisting in providing care and supervision to the children during today's inspection. LPA confirmed Adult #1 does not have a criminal record clearance and/or exemption or is associated to the facility.

On 1/29/2020, LPA's Lisa Rios and Helen Estrella observed Adult #1 at the facility and leaving upon arrival of LPA's The licensee stated Adult #1 arrived for an interview and was not assisting in child care duties. LPA Estrella spoke to Adult #1 who confirmed had arrived 5 minutes prior to LPA's arrival and was going to talk to the licensee to see if she would be hired to work at the facility. LPA's observe Adult #1 leave the facility immediately. LPA's informed the licensee that it is recommended she conduct interviews for potential hire of staff or adults who wish to provide care and supervision at the facility during non-child care hours of operation. The licensee reiterated that Adult #1 was not providing care and supervision nor assisting at that time.
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)
Page: 1 of 3
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: 01/30/2020
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 was advised that, once licensed, 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, (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 is not operating within substantial compliance with the Title 22 and Health and Safety Code regulations at time of visit. Type A violation was cited. A copy of this report, notice of site visit and appeal rights were provided to the licensee. Exit interview was conducted with the licensee.
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
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 01/30/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/31/2020
Section Cited

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Criminal Record Clearance: 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 obtain a California clearance or a criminal record exemption as required by the Department

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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: 01/30/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2020
LIC809 (FAS) - (06/04)
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