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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493414
Report Date: 03/12/2020
Date Signed: 03/12/2020 08:59:22 AM

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:DEJAN FAMILY CHILD CAREFACILITY NUMBER:
197493414
ADMINISTRATOR:DEJAN, KAMILAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 756-4809
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY:14CENSUS: DATE:
03/12/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Kamilah DejanTIME COMPLETED:
09:15 PM
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On 03/12/2020 at approximately 07:50AM, Licensing Program Analyst, Stella Gutierrez met with Licensee, Kamilah Dejan and explained the purpose of todays visit of an annual random inspection to ensure that facility is in compliance with Title 22 regulations and Health and Health Safety code standards. Upon arrival, LPA observed 0 children being supervised by licensee. Facility is license for a capacity of 14 children. Licensee guided LPA on a tour of the facility inside and out. Hours of operation are from 6:00 AM – 6:00 PM, Monday through Friday.

Areas identified in the sketch and observed by LPA, Gutierrez during today’s visit:
Interior:

This is a single-story dwelling, two bedroom, 1 ½ bathroom home with kitchen/dining, living room, and a Detached garage. There is no a pool on the premises There are no weapons kept on the premises. Family members residing in the home include Licensee and her child over the age of 18. The facility was inspected inside and outside for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning when compounds, and hazardous items that can pose a danger to children.

On limits areas include: Living room, dining room and bathroom #1. Living room is the main care area for the children. LPA observed age appropriate toys, learning materials, games and activities for children in care. All furniture was found in good repair, clean, and without hazards. The facility is currently completing renovations but no change to the physical plant. Children nap in the main care area. LPA, Gutierrez observed age appropriate equipment (COTS and MATS). Bathroom #1 to the left. LPA observed the bathroom to be in operable condition and free from hazards.

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020
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: DEJAN FAMILY CHILD CARE
FACILITY NUMBER: 197493414
VISIT DATE: 03/12/2020
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LPA observed a working smoke detector located in main play area, an operable carbon monoxide detector located in the kitchen area and 2A10-BC fire extinguisher in kitchen and a fully equipped first aid kit including a digital thermometer located in kitchen.

Off-limits areas include the following: Kitchen (child safety gate in place to make inaccessible), Cleaners/chemicals observed under kitchen sink without latch and sharp objects in drawer with latches. Bedrooms #1 and bedroom #2, and bathroom #2

Exterior


On limits areas include: Front yard only. Front yard has a gate around the perimeter.

Off limits areas include: : Full back yard, the detached garage. and side yard. There is a pool located in the back yard. The pool has 5 ft. mesh fence with a door gate that opens outward and has a latch. LPA observed the pool are to be inaccessible during today's visit.



Administration:

FORMS TO BE POSTED AND OBSERVED BY LPA during today’s visit in main care area.


· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster

Children’s roster observed and posted with other posting.


-Pediatric First Aid and Adult, Child and Infant CPR to be current (expires 05/2021) for all staff
-Preventative Health and Safety was observed today.
-Immunization records for Licensee were available to LPA to observe today.
Mandated reporter Training certification was observed today.

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: DEJAN FAMILY CHILD CARE
FACILITY NUMBER: 197493414
VISIT DATE: 03/12/2020
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LPA discussed capacity limitations, new car seat law, personal rights, Notification of Parent's Rights revised 12/06, inspection authority & agency's consultative role. Smoking is prohibited on the premises when children are present. The LPA also discussed earthquake safety and necessity of drills every 6 months. The applicant was also informed that all adults living in or having access to day care children in the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of $100 /day per uncleared adult will be assessed.

The facility is not currently providing IMS. Incidental Medical Services (IMS) policy was discussed with the Licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. LPA obtained a copy of the facility's IMS Plan. 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.html

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

Safe Sleep Links:
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx


NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: DEJAN FAMILY CHILD CARE
FACILITY NUMBER: 197493414
VISIT DATE: 03/12/2020
NARRATIVE
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SIDS & SHAKEN BABY SYNDROME INFORMATION (discussed) flyer provided.
Licensee was reminded that all infants must be placed on their backs when sleeping . LPA provided safe sleep flyer and discussed safe sleep practice. Infants must be placed on their backs and must be physically checked every 15 minutes to gauge temperature and ensure they are breathing 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. Licensee, Kamilah Dejan stated that she understands safe sleep practice and prevention of Shaken Baby Syndrome for infants and to ensure supervision at all times infants are in care a DEJAN FAMILY CHILD CARE facility.

Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation.

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.



New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. A copy provider rights and Appeal process provided to Licensee. All appeals must be sent to:

California Department of Social Services | Community Care Licensing Division
300 Continental Blvd., Suite 290-A
El Segundo, CA 90245

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.

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: DEJAN FAMILY CHILD CARE
FACILITY NUMBER: 197493414
VISIT DATE: 03/12/2020
NARRATIVE
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Assembly Bill 1207: California Child Care Workers; Mandated Training Requirement. Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete Mandated Reported Training prior to March 30, 2018 and renew training every two years at: www.mandatedreporterca.com. Volunteers are encouraged but not required to take the training. Providers are to complete the 4 hour General Training and 3 hour Child Care Provider Training. Licensee stated that she has not completed the Mandated Reporter Training.

Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university.

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.



Internet address for reports, regulations: DSSNET address: http://ccl.dss.cahwnet.gov/ and for children’s and employees forms: http://www.dss.cahwnet.gov/getinfo/pubintro.html#1

Licensee currently does not receive quarterly updates and will be registered by LPA. An updated email was received during today’s visit.


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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: DEJAN FAMILY CHILD CARE
FACILITY NUMBER: 197493414
VISIT DATE: 03/12/2020
NARRATIVE
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The Facility was found to be operating within substantial compliance per Title 22 regulations and Health and Safety Codes standards during today’s visit. There will be no deficiencies cited today.

An exit interview was conducted and a copy of this report, appeal rights along with the notice of site visit were provided to Kamilah Dejan, Licensee.


The licensee was advised that 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, 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. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 6 of 6