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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494425
Report Date: 12/10/2021
Date Signed: 12/10/2021 11:50:41 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:AMBREEN FAMILY CHILD CAREFACILITY NUMBER:
197494425
ADMINISTRATOR:AMBREEN, AYESHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 687-2408
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:14CENSUS: 0DATE:
12/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ayesha AmbreenTIME COMPLETED:
12:15 PM
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On 12/10/2021, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced Annual Required Inspection and met with Licensee, Ayesha Ambreen. Days and hours of operation are Monday through Friday, 7:00AM – 6:00PM.

LPA toured the inside and outside of the two-story home with 4 bedrooms, 3 bathrooms, living room, kitchen, dining room, living room, family room, laundry room, an office, a two-car attached garage, a single car attached garage, front yard, and back yard. An Entrance checklist (LIC 126) was provided to Licensee at the start of today’s inspection. Current facility sketch reviewed, and Licensee confirmed that the family room, living room, dining room, bathroom 1, and backyard are the childcare areas. Off-limits areas are: kitchen, bedrooms, bathroom 1, bathroom 2, laundry room, garages, and front yard. The primary childcare area is the living room. LPA observed 14 cots, toys, and educational materials in the living room. LPA observed a child safety gate blocking off the living room from the kitchen. Doors to the garage and office are kept locked with a key. In bathroom 1, LPA observed 1 toilet, 1 sink, and 1 shower. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The fireplace located in the family room is made inaccessible by a screen with a child safety latch and will not be in use during day care hours. The family room is used a walkway between the living room and backyard, which is only accessible via the family room. There is a 2A10:BC fire extinguisher in the kitchen and a functioning smoke/carbon monoxide detector in the family room. LPA observed a child safety gate at the bottom and top of the stairs, making the second floor inaccessible. The outdoor play area in the backyard is fenced and there are no hazards to children present. Safe toys and play equipment were observed. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises.



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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
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 3
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: AMBREEN FAMILY CHILD CARE
FACILITY NUMBER: 197494425
VISIT DATE: 12/10/2021
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Capacity as specified on the license is being maintained. There are currently no children in care. LPA discussed the required children's files to be maintained with Licensee. Licensee’s and spouse's Mandated Reporter Training was completed on 12/7/2021. Licensee’s pediatric CPR/First Aid expires in 12/2023. 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
Criminal Record Statement
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 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.
Safe Sleep
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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations no deficiencies are cited.




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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: AMBREEN FAMILY CHILD CARE
FACILITY NUMBER: 197494425
VISIT DATE: 12/10/2021
NARRATIVE
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Staff interview conducted at 10:00 AM .

Notice of Site Visit
A notice of site visit was given and must remain posted for 30 days.

Exit Interview
Exit interview conducted and report was reviewed with the licensee, Ayesha Ambreen.

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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3