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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416878
Report Date: 05/03/2022
Date Signed: 05/03/2022 02:52:08 PM


Document Has Been Signed on 05/03/2022 02:52 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:MINWALLA FAMILY CHILD CAREFACILITY NUMBER:
197416878
ADMINISTRATOR:MINWALLA, SHAMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 801-8155
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY:14CENSUS: 6DATE:
05/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:SHAMA MINWALLA - LICENSEETIME COMPLETED:
03:00 PM
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On 5/3/2022 licensing Program Analyst (LPA), Jillinda Chandler conducted an unannounced Annual Random/ I year required visit for Minwalla Family Child Care Home. Present in the home was licensee Shama Minwalla supervising six day care children. The home is a single family, single story home. All areas of the home were inspected,not including two off limit bedrooms in the rear of the home
LPA observed the following:
Care and supervision were observed
The homes capacity was within the scope of the license
Appropriate size fire extinguisher carbon and smoke detector present & operable.
Detergents, and knives were inaccessible, Toxins were locked and inaccessible.
The homes kitchen was not inaccessible to children in care. Meals are provided by parents, kitchen appliances (stove) is not used during day care hour and no toxic chemical or supplies were stored in the kitchen. LPA advised licensee that if the stove should be used that the kitchen shall be made inaccessible. No guns or weapons present as stated by the Licensee, no weapons observed by LPA.
The home has a working telephone LPA observed the homes parent notification board; the license, facility sketch, Emergency Disaster Plan, Notification of Parent’s Rights Poster were observed. The following were not observed and were provided to licensee during todays visit; Lead Poison Awareness, Safe Sleep and California Safety Seat Law.
A first aid kit was observed containing the required supplies: scissors, tweezers, bandages, medical ointment and a thermometer.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2022
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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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: MINWALLA FAMILY CHILD CARE
FACILITY NUMBER: 197416878
VISIT DATE: 05/03/2022
NARRATIVE
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Personal records were not reviewed, licensee did not have an assistant during todays inspection.
Immunization records for licensee Sharma Minwalla were reviewed, licensee shall maintain notice of decline for the Influenza vaccination.
Licensees Mandated Reporter certificate expires 4/30/2024
A roster was readily available for review.
Parents and authorized adults do not sign children in and out. LPA advised the licensee that this was the best practice, for emergency purposes.
Licensee has procedures for Individual Medical Services (IMS). IMS was discussed with licensee.
All adults in the home cleared a Criminal Background Clearance.
Toys, equipment and materials available and in good order Children napped on cots were found to be in good condition.
Infant safe sleeping was discussed with licensee. LIC. 9227 and Safe Sleep For Your baby posters were provided. LPA reminded licensee that children are only to use car seats during transportation, and appropriate children’s feeding chairs shall only be used during mealtime. Outdoor activities were conducted in the back yard, grass was used for cushioning under the climbing apparatus. LPA did not observe any hazardous conditions in this area.
Children records available and in good order.
A current Pediatric CPR and First Aid certification was not available No bodies of water were observed on the premises
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
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: MINWALLA FAMILY CHILD CARE
FACILITY NUMBER: 197416878
VISIT DATE: 05/03/2022
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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 [or facility representative] 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Shama Minwalla

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 05/03/2022 02:52 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: MINWALLA FAMILY CHILD CARE
FACILITY NUMBER: 197416878

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based onrecord review, the licensee did not comply with the section cited by not one person present had current CPR/First Aid training which poses a potential safety risk to persons in care.
POC Due Date: 05/13/2022
Plan of Correction
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Licensee shall provide current certification by the due date of 5/13/2022
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

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 5 out of 5 files did not contain receipt or copies of the required notifications which poses a personal rights risk to persons in care.
POC Due Date: 05/13/2022
Plan of Correction
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Licensee shall provide all parents with the as bove notifications, and provide LPA with a signed roster from parents or authorized representatives acknowleding receipt of such forms, no later than the due date of 5/13/2022

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: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2022
LIC809 (FAS) - (06/04)
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