197418568-3-9-2023-58-CC-DLOE-CPRUCH-20230309142800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197418568
Report Date: 03/09/2023
Date Signed: 03/09/2023 02:28:18 PM

Document Has Been Signed on 03/09/2023 02:28 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	BEN-DAVID FAMILY CHILD CARE		FACILITY NUMBER:	197418568
ADMINISTRATOR:	BEN-DAVID, ESTER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 339-1220
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	14	CENSUS: 6	DATE:	03/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Ester Ben-David		TIME COMPLETED:	02:35 PM

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On 03/09/2023 Licensing Program Analyst (LPA) Deborah Lowe met with Licensee, Ester Ben-David. The purpose of the visit was an unannounced annual inspection at the home to ensure that health, safety and personal rights as requires by Title 22 and Health and Safety Regulations governing California Child Care Homes will be met. The Family Child Care Home operates Monday – Friday 8:00 a.m. – 4:00 p.m.

LPA Lowe observed 6 children under supervision of licensee and assistant (S1).

Home is observed as a single-story home with living room, dining room, kitchen, three bedrooms, children’s playroom, and 3 ½ bathrooms. LPA Lowe reviewed facility sketch with licensee and facility sketch matches the floor plan of the home.

No area of the facility sketch is listed as off-limits. Child care is primarily conducted in the children’s play room with bathroom located in children’s playroom. Children and parents enter home from side gate and door on side of home that leads to bathroom located in playroom, then enters playroom from bathroom. Per licensee, children and parents do not enter other areas of the home.

LPA Lowe observed a working combination carbon monoxide/smoke detector in the home, LPA Lowe was able to hear a successful test. Combination detector was located in the child care playroom. Fire extinguisher 2A10BC or larger was observed, located in laundry closet. Electrical outlets were observed to be inaccessible to children in care with the use of plug covers. The home was observed to be clean and orderly with heating and ventilation. LPA observed safe toys, play equipment, and materials. LPA Lowe verified the home has a working telephone service.

LPA observed cleaning compounds and detergents inaccessible to children. LPA advised poisons shall be locked with a key or a combination lock.

Cots were observed for napping. No play yards or cribs observed in home. LPA advised, if adding a crib or

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BEN-DAVID FAMILY CHILD CARE	FACILITY NUMBER: 197418568
	VISIT DATE: 03/09/2023

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play yard to home the there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. LPA advised, the placement of cribs or play yards shall not hinder entrance or exit to and from the space where infants are sleeping. LPA advised, mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. Mattresses shall be made specifically for the size crib or play yard in which they are placed. LPA advised, cribs or play yards shall be free from all loose articles, objects, bumper pads shall not be used, and there shall be no objects hanging above or attached to the side of the crib.

There is a Firearm in home, firearm was observed in a locked safe away from children's playroom. Home was observed with no fireplaces or open face heaters.

Kitchen was observed with sharp utensils and hazards inaccessible to children. Kitchen was observed to be clean. Kitchen is inaccessible to children with the use of door from playroom. Per licensee facility provides all food for the children.

Bathroom(s) were observed to be clean with toilet and faucet safe and operable. Bathtub and shower are free of hazards. LPA advised shampoos, mouthwash, soap, medication, perfumes, razor blades, air freshener, nail polish/ remover shall be inaccessible to children.

Outdoor area is located back yard/ side near child care playroom door. Outdoor area was observed to be fenced in. LPA observed a pool located in the backyard. Pool was observed to be inaccessible by the use of surrounding the pool with a white metal fence. LPA Lowe measured fence. Fence measured 5 feet tall. Fence was observed to not obscure the pool from view. Pool gate was observed to 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.

When a child is ill, they will be separated from the other children by placing a cot away from the other children in the daycare room.

LPA advised smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

LPA advised, fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Safety Commission shall not be used for children in care or accessible to children in care. page 2 of 5

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BEN-DAVID FAMILY CHILD CARE	FACILITY NUMBER: 197418568
	VISIT DATE: 03/09/2023

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LPA Lowe reviewed five of children’s records and found records to be complete with emergency cards, immunization records, notification of parent’s rights. LPA reviewed Individual sleeping plans and documentation of 15-minute safe sleep checks. LPA Lowe advised 15-minute safe sleep documentation shall be completed for all children under 24 months of age.

During file review of children’s records LPA Lowe found 5 out of 6 children present were under 24 months old: C2, C3, C4, C5, and C6 were between the ages of 1-years-old to 1-year-11-months old. LPAs advised per CC Regulation 102416.5(d)(1) Staffing Ratio and Capacity (d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants.

Facility is found to be out of ratio. LPA Lowe advised per CC Regulation 102352(1) Definitions (i) "Infant" means a child under two years of age. Facility will receive a type A citation for this deficiency. LPA Lowe provided and reviewed with Licensee the Capacity Regulations For Family Child Care Home License flyer.

License sent an infant (C6) home during visit. Facility was observed to be in ratio at 11:35 am.

Review of facility and staff records found Licensee has Preventive Health Practices but was unable to provide a current Pediatric CPR or Pediatric First Aid certification. LPA Lowe advised per CC Regulation 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. Facility will receive a type B citation for this deficiency.

Review of staff records, LPA found facility did not have proof S1 has been immunized against pertussis or measles. LPA advised per H&S Code 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. Facility will receive a type B citation for this deficiency.

LPA Lowe observed the following required postings: LIC610A Emergency Disaster Plan, PUB 394 Notification of Parents’ Rights Poster, and LIC 9148 Earthquake Preparedness Checklist. page 3 of 5

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BEN-DAVID FAMILY CHILD CARE	FACILITY NUMBER: 197418568
	VISIT DATE: 03/09/2023

NARRATIVE

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LPA advised all LIC9213 Notice of Site Visits shall be posted for 30 days after each site visit. LPA advised, any licensing report documenting a Type A citation must be posted for 30 days. LPA observed the facilities disaster drill log showing disaster drills are completed at lease every six months.

LPA advised the licensee shall reveal each child care center license number in all advertisements in accordance with Health and Safety Code Section 1596.861.

LPA advised per CC Regulation 102417(a) Operation of A Family Child Care Home The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

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.

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SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

Page: 4 of 9

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BEN-DAVID FAMILY CHILD CARE	FACILITY NUMBER: 197418568
	VISIT DATE: 03/09/2023

NARRATIVE

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LPA reviewed with Licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA Deborah Lowe informed licensee Ester Ben-David that this report dated 03/09/2023 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deborah Lowe informed the licensee to provide a copy of this licensing report dated 03/09/2023 that documents any Type A citation(s) 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.

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

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

Appeal Rights were reviewed and provided.

Exit interview conducted and report was reviewed with the licensee Ester Ben-David.

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SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

Page: 5 of 9

Document Has Been Signed on 03/09/2023 02:28 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BEN-DAVID FAMILY CHILD CARE	FACILITY NUMBER: 197418568
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(d)(1)

Staffing Ratio and Capacity

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview with licensee, and record review, the licensee did not comply with the section cited above in 5 out of 6 children present were infants. C2, C3, C4, C5, and C6 were under 24 months old which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/09/2023
	Plan of Correction
1 2 3 4	During visit LPA Lowe observed Licensee send C6 home, facility was observed to be in ratio by 11:35 am. Licensee provided LPA Lowe with an LIC 855 Declaration stating they understand they can only have 4 infants at one time. LPA Lowe advised 4 kids at a time when assistant is present.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

Page: 6 of 9

Document Has Been Signed on 03/09/2023 02:28 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BEN-DAVID FAMILY CHILD CARE	FACILITY NUMBER: 197418568
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/09/2023

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
1 2 3 4	Based on interview with licensee and record review, the licensee did not comply with the section cited above in licensee was not able to provide proof of current pediatric CPR or First Aid which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/07/2023
	Plan of Correction
1 2 3 4	Per Licensee they will take the CPR/First Aid course and email LPA Lowe verification of completion on or before end of business on 04/07/2023. LPA Lowe provided email address as: deborah.lowe@dss.ca.gov.

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
1 2 3 4	Based on interview with licensee and record review, the licensee did not comply with the section cited above in Licensee did not have proof S1 has been immunized against pertussis or measles which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/23/2023
	Plan of Correction
1 2 3 4	Per Licensee, they advised S1 to bring immunization verification to licensee. Per Licensee they will email LPA Lowe proof S1 has been immunized against pertussis and measles on or before end of business on 03/23/2023. LPA Lowe provided email address as: deborah.lowe@dss.ca.gov.

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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

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