197419136-3-15-2023-58-CC-DLOE-CPXSTE-20230315140926

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419136
Report Date: 03/15/2023
Date Signed: 03/15/2023 02:09:43 PM

Document Has Been Signed on 03/15/2023 02:09 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:	HARIRI FAMILY CHILD CARE		FACILITY NUMBER:	197419136
ADMINISTRATOR:	HARIRI, JINNA G.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 887-2179
CITY:	WOODLAND	STATE: CA	ZIP CODE:	91367
CAPACITY:	14	CENSUS: 12	DATE:	03/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	Jinna Hariri		TIME COMPLETED:	02:10 PM

NARRATIVE

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On 03/15/2023 Licensing Program Analyst (LPA) Deborah Lowe met with Licensee, Jinna Hariri. 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 7:30 a.m. – 5:00 p.m.

LPA Lowe observed 12 children under supervision of licensee and two assistants (A1) (A2).

Home is observed as a single-story home with living room, side room to living room, kitchen, three bedrooms, and 2 bathrooms. LPA Lowe verified the living room, side room to living room, back bedroom, and bathroom near side room are used for daycare. The two front bedrooms and bathroom in hallway near front bedrooms, and kitchen are off-limits. Off-limit areas are made off-limits with the use of doors and for the kitchen a child’s gate is used.

LPA Lowe observed a working carbon monoxide detector in the home, LPA Lowe was able to hear a successful test. Carbon monoxide detector is located in the hallway near the back bedroom. Fire extinguisher 3A40BC was observed, located in off-limits area of hallway near kitchen. 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 a Meyers cleaning bottle with cloth located on a low shelf in the living room accessible to children in care (picture was taken). LPA Lowe advised per CC Regulation 102417(g)(4) Operation of A Family Child Care Home (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. Facility will receive a type A citation for this deficiency.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: HARIRI FAMILY CHILD CARE	FACILITY NUMBER: 197419136
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview with licensee, the licensee did not comply with the section cited above in one Meyers cleaning compound spray bottle was left on a low shelf in living room accessible to children which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/15/2023
	Plan of Correction
1 2 3 4	During visit LPA Lowe observed the licensee remove the Meyers cleaning bottle and placed with other cleaning compounds and detergents in a cabinet located in an off-limits hallway near the kitchen making it inaccessible to children. Licensee spoke with assistances advising cleaning bottles are never to be left out.

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: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: HARIRI FAMILY CHILD CARE	FACILITY NUMBER: 197419136
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(b)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in two out of three cribs LPA observed blankets and toys inside the cribs which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/15/2023
	Plan of Correction
1 2 3 4	During visit LPA Lowe observed A1 remove all items from the cribs.

Type B

Section Cited

CCR

102425(b)(3)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. (3) There shall be no objects hanging above or attached to the side of the crib. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in one out of three cribs with a soft toy attached to the side of the crib with toy haning inside the crib which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/15/2023
	Plan of Correction
1 2 3 4	During visit LPA Lowe observed A1 and licesee remove the toy that was observed to be attached to the side of the crib.

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: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: HARIRI FAMILY CHILD CARE	FACILITY NUMBER: 197419136
	VISIT DATE: 03/15/2023

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Licensee removed the cleaning bottle and placed with other cleaning compounds and detergents in a cabinet located in an off-limits hallway near the kitchen making it inaccessible to children. Area was observed as off-limits with use of child gates. LPA advised poisons shall be locked with a key or a combination lock.

LPA Lowe observed three cribs and one play yard was observed in the back bedroom. LPA observed blankets and toys in two of the cribs (picture taken). No children were observed in the cribs or the play yard. LPA advised per CC Regulation 102425(b) Infant Safe Sleep (b) Cribs or play yards shall be free from all loose articles and objects. Facility will receive a type B citation for this deficiency.

LPA Lowe observed one crib to have a soft toy attached to the side of the crib wit the toy hanging in the crib (picture taken). LPA advised per CC Regulation 102425(b)(3) Infant Safe Sleep (3) There shall be no objects hanging above or attached to the side of the crib. Facility will receive a type B citation for this deficiency.

LPA Lowe discussed with licensee how important safe sleep is in caring for children under 24 months. LPA advised the risks of injury and possible death. LPA Lowe reviewed and provided licensee with PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect with licensee.

Per licensee there are no firearms in home. Home was observed a fireplace in the living room with a glass barrier.

Kitchen was observed to be inaccessible with the use of a child’s gate. Kitchen was observed to be clean. Per licensee facility provides all food for the children.

Bathroom was observed to be clean with toilet and faucet safe and operable. Home was observed with no bath tub or shower in the bathroom children use. Children’s bathroom was observed with two toilets, one toilet is in the place of a stall shower. No hazards were observed in the bathrooms.

Outdoor area is located in the back yard. 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 black pool fencing. 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.

LPA advised smoking is prohibited on the premises of a family child care home as specified in Health and

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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: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: HARIRI FAMILY CHILD CARE	FACILITY NUMBER: 197419136
	VISIT DATE: 03/15/2023

NARRATIVE

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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.

LPA Lowe reviewed six random children’s records and found records to be complete with emergency cards, immunization records. One file reviewed was in need of notification of parent’s rights. LPA Lowe advised 15-minute safe sleep documentation shall be completed for all children under 24 months of age. LPA Lowe provided license with an example of a sleep log and LIC 9227 Individual Sleep Plan for all children 12 months and under. Currently there are no children under 12 months enrolled in facility.

Review of facility records found Licensee has Preventive Health Practices and a current Pediatric CPR/First Aid certification.

Review of staff records were found to be complete with mandated reporter trainings and immunization records on file for influenza, pertussis and measles. LPA Lowe verified background clearances and found A1 and A2 have a background clearance and are associated to the facility.

LPA Lowe observed the following required postings: License, PUB 394 Notification of Parents’ Rights Poster, and disaster drill log. LPA advised all LIC9213 Notice of Site Visits shall be posted for 30 days after each site visit. LPA reviewed 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.

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 page 3 of 4

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: HARIRI FAMILY CHILD CARE	FACILITY NUMBER: 197419136
	VISIT DATE: 03/15/2023

NARRATIVE

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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.

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 Jinna Hariri that this report dated 03/15/2023 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 03/15/2023 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 Jinna Hariri. page 4 of 4

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

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