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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493580
Report Date: 01/24/2020
Date Signed: 01/28/2020 10:01:19 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:ALFASI FAMILY CHILD CAREFACILITY NUMBER:
197493580
ADMINISTRATOR:ELINOR ALFASIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 216-9561
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:14CENSUS: 9DATE:
01/24/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Elinor Alfasi/LicenseeTIME COMPLETED:
01:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit . LPA met with the licensee and toured the home inside and outside at 10:40 AM on 01/24/2020. Licensee was present with ten children ( including five infants) and two assistants ( fingerprint cleared and associated to the facility) at the time of the visit. All areas identified on the facility sketch were inspected. Licensee's home is a single story 2 bedroom, 2 bathroom home with living room, dining/family room, kitchen, and small office. There is a detached garage that has been converted into a playroom and it contains 1 bathroom. Family members residing at the facility are: 2 adults ( licensee and her husband) and one child ( licensee's 2 month old daughter). There is no pool, spa or other bodies of water on the premises. Main care is provided in the day care room located in the detached, converted garage and the living room. The living room is located at the rear of the home through an exterior door near the detached play room. The bedrooms and the bathroom in the bedroom are off limits to the children in care The children have access to the bathroom located in the hall way. Children play in the back and left side yards which is fenced. LPA inspected the converted garage. The garage has not been fully converted and applicant is fully aware that children may not eat or sleep in the garage. Children eat and sleep in the living room. The main entry door is not be used to enter the facility. Parents and children will use the side gate and the back doors leading to the living room. There is no pool, spa or other bodies of water on the premises. Licensee has an operating smoke/carbon monoxide detectors in the child care room as well as an operating and fully charged Fire Extinguisher. Licensee reports she has no firearms or weapons in the home. LPA also observed Licensee's and assistant's current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 7/29/2021). The bathroom in the hall way and in the garage, and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care. LPA observed the yard to be clean, free of debris, and fully fenced. The First Aid kit was observed, and complete. Page 1
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: ALFASI FAMILY CHILD CARE
FACILITY NUMBER: 197493580
VISIT DATE: 01/24/2020
NARRATIVE
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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.
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. Licensee's and assistants' immunization records are not available for review.
Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensee and assistants have not taken the training.

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. Page 2

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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: ALFASI FAMILY CHILD CARE
FACILITY NUMBER: 197493580
VISIT DATE: 01/24/2020
NARRATIVE
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New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

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.

LPA discussed and provided the safe sleep for baby pamphlet. Each infant shall be constantly supervised and under direct visual observation by an adult person at all times. Under no circumstances shall any infant be left unattended. In order to visually observed and supervise sleeping infants there should be no obstruction to the view of the infants, which could include transparency walls and/or half walls. LPA recommend that infants sleep safest in crib with no bumpers, pillows, blankets, or toys, and on their backs, and every sleep time counts to reduce the risk of SIDS and other sleep related causes of infant death.



Facility was cited one Type A and two Type B deficiencies. See Facility Evaluation Report LIC 809-D for deficiencies cited.


Exit interview was conducted and a copy of the report was provided.

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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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: ALFASI FAMILY CHILD CARE
FACILITY NUMBER: 197493580
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2020
Section Cited

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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:


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Twelve children, no more than four of whom may be infants; or
LPA observed 10 children were present. 5 infants and 5 preschool children.
Operating beyond the limitations of a license poses an immediate health and safety risk to children in care
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 Licensee will give notices to the parents of the children who will no longer attend care at the facility and submit copies of these letters to CCL by 01/31/2020. POC visit will be conducted to verify compliance

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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: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 2 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: ALFASI FAMILY CHILD CARE
FACILITY NUMBER: 197493580
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/07/2020
Section Cited

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Mandated Reporter: On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete
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renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.The requirement is not met as evidenced by: file review on 11/13/2019, licensees had not taken the required training. This is a potential risk to the health and safety of children in care
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Type B
02/07/2020
Section Cited

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Employees or volunteers at family day care home; immunization requirements; records; exemptions: 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.
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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:Licensee's assistant's immunization records are not available for review
This poses a potential risk to the health and safety of children in care
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The licensee must show proof of immunization no later than the close of business on 02/07/2020
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: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 4 of 5