197493662-5-5-2022-30-CC-SORS-CE65D6-20220505195127

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493662
Report Date: 05/05/2022
Date Signed: 05/05/2022 07:53:34 PM

Document Has Been Signed on 05/05/2022 07:53 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	NIK FAMILY CHILD CARE		FACILITY NUMBER:	197493662
ADMINISTRATOR:	NIK, FATEMEH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 456-2981
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	14	CENSUS:	DATE:	05/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:34 PM
MET WITH:	Fatemeh Nik-Licensee		TIME COMPLETED:	07:51 PM

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On 5/5/2022 at 12:34pm Licensing Program Analysts (LPAs) Suzette Ornelas and Deborah Lowe , conducted an unannounced Annual Required Inspection and was met by Adult 1 who answered door and then met with licensee Fatemeh Nik. Days and hours of operation are Monday through Friday 6:30am to 6:00pm.

LPAs toured the home inside and outside and a census was taken. LPAs observed 7 children in care with licensee. Current facility sketch reviewed and Licensee confirmed that the bathroom and play room are used for providing care and are accessible to children. The living room is used for when the children walk to the bathroom. All other rooms are off-limits and made inaccessible by use of child safety gate and safety knobs on doors. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. All poisons shall be kept in a locked storage area. Poison/pesticide was observed during the inspection in the backyard area, inaccessible to children not in a locked storage. CCR 102417(g)(4)(A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

Detergents, and medication are made inaccessible. At approximately 3:15pm, LPAs observed a child with an open pocket sized hand sanitizer from a backpack child was sitting next to. Child was observed squeezing hand sanitizer out onto the floor. LPAs informed licensee and licensee redirected child by removing the hand sanitizer immediately from child’s possession and making it inaccessible to children in care. This will result in a Type A citation per CCR 102417(g)(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.

LPAs observed a prohibited item, baby walker, in the backyard outdoor play yard accessible to children in care. LPAs advised per CCR 102417(g)(10) 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).

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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: NIK FAMILY CHILD CARE	FACILITY NUMBER: 197493662
	VISIT DATE: 05/05/2022

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The fireplace located in the living room is made inaccessible by a glass door and will not be in use during daycare hours. Per licensee, open face heater in on-limits restroom is disconnected. LPAs verified it was not working. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home.

At 12:40pm, LPAs observed play yard leg broken and disconnected from frame causing it to tilt with child seen sleeping inside. LPAs advised per CCR 102417(d) The home shall provide safe toys, play equipment and materials.

The outdoor play area in the backyard is fenced. During outdoor inspection at approximately 1:10pm, LPAs observed the backyard outdoor play area with multiple hazards including, access to wood with exposed nails, ax, grill, large garden scissors, unsecured tools and nails on top of the shed area accessible to children. Outdoor play equipment needs to be cleaned regularly by removing spider webs. Outdoor air conditioning system needs to be made inaccessible to children care. LPAs advised per CCR 102417(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to.

The home has working telephone service and LPA confirmed the phone number is (818)456-2981.

There are currently infants in care. LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care. At 12:40pm, LPAs observed 2 children under 24 months sleeping in play yard with 2 pillows and a small blanket in each play yard. LPAs advised licensee to remove all items and licensee removed all items immediately. This will result in a Type A citation per CCR 102425(b) (b) Cribs or play yards shall be free from all loose articles and objects.

There are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes but does not documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. LPAs advised licensee needs to document daily on an infant sleep log. Infants can be visually observed through an open door if sleeping in a separate room. LPAs advised licensee that an Individual Infant Sleeping Plan shall be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age shall be placed on their backs for sleeping.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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: NIK FAMILY CHILD CARE	FACILITY NUMBER: 197493662
	VISIT DATE: 05/05/2022

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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is not being maintained. LPAs observed licensee without assistant and caring for 7 children, 4 of which were found to be infants under 24 months, after record review. At 1:50 pm, 1 of the 4 infants was picked up by parent, therefore putting the licensee back into compliance. LPAs advised that when licensee is not with assistance capacity is 6 with no more than 3 infants. Licensee stated no school aged children enrolled.

After record review, LPAs found that 4 out of the 7 children in attendance were infants. This will result in a Type A citation per CCR 102416.5(b)(2) Six children, no more than three of whom may be infants;

LPAs reviewed a sample of children’s files and observed that 6 out of 7 children’s files were complete with emergency information as required. Licensee’s Mandated Reporter Training is shown as complete and up to date. Licensee’s pediatric CPR/First Aid expires on 06/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPAs and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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: NIK FAMILY CHILD CARE	FACILITY NUMBER: 197493662
	VISIT DATE: 05/05/2022

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LPAs Suzette Ornelas and Deborah Lowe informed licensee Fatemeh Nik that this report dated 5/5/2022 that documents 3 Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/05/2022 07:53 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: NIK FAMILY CHILD CARE	FACILITY NUMBER: 197493662
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/05/2022

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, the licensee did not comply with the section cited above in a child was observed squeezing a pocket sized hand sanitizer out onto the floor which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2022
	Plan of Correction
1 2 3 4	Licensee redirected child by removing the hand sanitizer immediately from childs possession and making it inaccessible to children in care. Licensee will review the childcarevideos.org and watch: Locks and inaccessability requirements in child care, video. Licensee will provide a written statement of video understanding.

Type A

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 2 children under 24 months sleeping in play yard with 2 pillows and a small blanket in each play yard which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2022
	Plan of Correction
1 2 3 4	Licensee removed all items immediately. Licensee will provide a written decleration.

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: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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: NIK FAMILY CHILD CARE	FACILITY NUMBER: 197493662
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(b)(2)

Staffing Ratio and Capacity

(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (2) Six children, no more than three 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, record review, the licensee did not comply with the section cited above in that 4 out of the 7 children in attendance were infants ages under 24 months which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2022
	Plan of Correction
1 2 3 4	1 of the 4 infants was picked up by parent, therefore putting the licensee back into compliance. Licensee will review the childcarevideos.org and watch: How many children can attend a family child care home? video. Licensee will provide a written statement of video understanding.

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: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/05/2022 07:53 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: NIK FAMILY CHILD CARE	FACILITY NUMBER: 197493662
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(d)

Operation of A Family Child Care Home

(d) The home shall provide safe toys, play equipment and materials. 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 play yard leg is broken and disconnected causing it to tilt while child were seen sleeping inside which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2022
	Plan of Correction
1 2 3 4	Licensee stated will remove today, will send picture of verification on or before due date.

Type B

Section Cited

CCR

102417(g)

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: 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 that although children were not observed in the outdoor area at the time, children have access to multiple hazards in the backyard outdoor play area including, access to wood with exposed nails, ax, grill, large garden sissors, unsecured tools and nails on top of the shed area accessible to children. Play equipment needs to be cleaned regularly by removing spider webs. Outdoor air conditioning system needs to be made inacessible to children care which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/23/2022
	Plan of Correction
1 2 3 4	Licensee will provide proof of corrections on or before en of buissness day on 5/23/2022.

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: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/05/2022 07:53 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: NIK FAMILY CHILD CARE	FACILITY NUMBER: 197493662
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)(A)

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. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked. 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 having pesticide outside of the home. When standing in the front of the home, it is on the right side of the home. Pesticide was innacessible to children but not in a locked storage, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2022
	Plan of Correction
1 2 3 4	Licensee stated will remove this evening and send picture verification showing it is no longe rin the outdoor area and a picture showing the locked area it is stored in.

Type B

Section Cited

CCR

102417(g)(10)

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: (10) 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). 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 observed a prohibited item, baby walker, in the backyard outdoor play yard accessible to children in care which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2022
	Plan of Correction
1 2 3 4	Licensee was observed placing the baby walker during visit in the trash. Licensee stated understanding of not having walkers in the facility.

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: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/05/2022 07:53 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: NIK FAMILY CHILD CARE	FACILITY NUMBER: 197493662
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review the licensee did not comply with the section cited above in licensee did not have required forms available for Child 7 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2022
	Plan of Correction
1 2 3 4	Licensee contacted parent and informed her to submit required paperwork today. LPAs observed licensee in phone communication with parent. Licensee will send forms to LPA on or before 5/9/2022.

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: 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 licensee, was unaware of the safe sleep regulation. Does not have infant safe sleep log for any of the infants in care which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2022
	Plan of Correction
1 2 3 4	Licensee contacted parent and informed her to submit required paperwork today. LPAs observed licensee in phone communication with parent. Licensee will send forms to LPA on or before 5/9/2022.

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: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

Page: 9 of 17

Document Has Been Signed on 05/05/2022 07:53 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: NIK FAMILY CHILD CARE	FACILITY NUMBER: 197493662
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in licensee without assistant and caring for 7 children, 4 of which were found to be infants after record review. 1 of the 4 infants was picked up by parent, therefore putting the licensee back into compliance which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2022
	Plan of Correction
1 2 3 4	Licensee without assistant and caring for 7 children, 4 of which were found to be infants after record review. 1 of the 4 infants was picked up by parent, therefore putting the licensee back into compliance. Licensee was in compliance by the time LPAs left.

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: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

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