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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492991
Report Date: 05/23/2019
Date Signed: 05/23/2019 02:16:52 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:SAHIN FAMILY CHILD CAREFACILITY NUMBER:
197492991
ADMINISTRATOR:SAHIN, NICOLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(747) 529-6272
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:14CENSUS: 7DATE:
05/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nicole SahinTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Marina Pilossian conducted a site visit for the purpose of an Annual Random visit . LPA met with the licensee and toured the home inside and outside on 05/23/19 at 11:35am. LPA observed licensee and her assistant with 7 children ( five infants and two preschool age children) in the facility. There was a dog at the facility and is kept in the off limit area during operation hours.

The licensee's home is a single story home with 3 bedrooms, 2 bathrooms, and one living room, dining area, a kitchen, converted garage/guest room, a den and a laundry room. There are front and back yards .. Off limit areas are all bedrooms, the kitchen, the master bathroom, living room, the laundry , the second backyard adjacent to the master bedroom and the guest room. Outdoor play area will be conducted in the back yard. Family members residing in the home include 3 adults (licensee and her parents) and no children. Main care is provided in the day care room/den at the rear of the home and the back yard. Licensee has a play pen available. Licensee has safety devices over the door knobs, making the rooms inaccessible to children. There is no pool, spa or other bodies of water on the premises. LPA observed the CERTIFICATE OF OCCUPANCY from the City Of Los Angeles posted on the parent board.

The home was found to be clean and orderly with proper ventilation for safety and comfort. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. The kitchenette cabinets and drawers were inspected for inaccessibility of toxins/chemicals, knives and other sharp objects which may be harmful to children in care. The Fire Extinguisher (2A-10-BC) is mounted on the wall in the child care room. There is a working smoke and Carbon Monoxide detectors located in the child care room. Licensee and assistant have current CPR or First Aid. Current CPR and First Aid expires on 12/01/2020.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
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: SAHIN FAMILY CHILD CARE
FACILITY NUMBER: 197492991
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/23/2019
Section Cited
CCR
102416.5(d)(1)
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 102416.5 Staffing Ratio and Capacity
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,
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Licensee agrees to reduce the numbar of infants to two effective immediately when licensee is operating at a small capacity (8) or less children. Licensee will submit a current Roster and schedule of each infant to CCL with the names of the children who are still enrolled at the facility. Licensee will give notices to the parents of
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 shall be either: (1) Twelve children, no more than four of whom may be infants; or fourteen children, no more than three infants.
This requirement is not met as evidenced by:
Licensee had 5 infants and 2 preschool age children in care. This is a type A dificiency as it poses immediate hazard to health and safety of children in care.
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the children who will no longer attend care at the facility and submit copies of these letters to CCL by 05/30/2019

POC visit will be conducted to verify compliance.
Licensee called the parents while LPA was present to come and pick up their children.
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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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: SAHIN FAMILY CHILD CARE
FACILITY NUMBER: 197492991
VISIT DATE: 05/23/2019
NARRATIVE
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Applicant was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Applicant was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation. Applicant was provided an informational pamphlet titled, "Safe Sleep For Your Baby" during the inspection. Applicant was also provided an informational sheet titled, "What Does a Safe Sleep Environment Look Like?" to review and post at the facility.

Appeal Rights were printed and provided. Type A deficiency was cited. Acknowledgement receipt (LIC 9224) was printed and provided. LPA explained to licensee that she must provide the copy of this report and the LIC809D report to parents and guardians of all children enrolled at the day care and to parents and guardians of new children that will enroll up to 12 months from the date of this report.

Exit interview conducted and a copy of this report was printed and provided to the licensee.

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: SAHIN FAMILY CHILD CARE
FACILITY NUMBER: 197492991
VISIT DATE: 05/23/2019
NARRATIVE
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Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. Licensees' immunization are not up to date.
New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

Update on Incidental Medical Services:

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541


Email Address: childcareadvocatesprogram@dss.ca.gov
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: SAHIN FAMILY CHILD CARE
FACILITY NUMBER: 197492991
VISIT DATE: 05/23/2019
NARRATIVE
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The licensee and assistant completed the Mandated Reporter Training on 02/13/18. Licensee's and assistant's immunization are up to date. The First Aid kit was observed, and complete. LPA observed the fire drill log. The fire drills are done every month.
LPA observed toys and furniture that were age appropriate and in good repair.
LPA toured the backyard and found it to be fully fenced.

Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , Child Care Facility Roster (LIC9040), Emergency Disaster Plan (LIC610a).

A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card.

The following was thoroughly discussed with the licensee:

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5