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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494852
Report Date: 08/19/2021
Date Signed: 08/19/2021 11:51:01 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:BEN EZRA FAMILY CHILD CAREFACILITY NUMBER:
197494852
ADMINISTRATOR:RACHEL BEN EZRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 489-8231
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:14CENSUS: 0DATE:
08/19/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Rachel Ben-EzraTIME COMPLETED:
11:45 AM
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On 8/19/2021 at 10:20AM, Licensing Program Analysts (LPAs) Lillian Casillas and Judy Laureano conducted an announced Pre-Licensing Inspection for a Change of Location. LPAs met with Licensee, Rachel Ben-Ezra, who guided LPAs on a tour of the inside and outside of the home. LPAs observed 0 adults and 0 children in care. Hours of operation are scheduled for Monday through Friday, 8:00AM-5:00PM.

Licensee is applying for a Large Family Child Care Home with maximum capacity of 14 children, ages 0 to 4 years old. Licensee is currently licensed for a large family child care home #197493591 located at 12601 Hatteras Street, North Hollywood, CA 91607.

This is a single-story house with 4 bedrooms, 2 bathrooms, living room, kitchen, dining room, laundry room, front yard, back yard, storage room, and guest house with a kitchen and bathroom. Childcare areas are: dining room, living room, kitchen, backyard, and guest house with bathroom 3. Off-limits areas are: bedroom 1, bedroom 2, bedroom 3, bedroom 4, bathroom 1, bathroom 2, storage room, and front yard.

Indoor


LPAs entered the property through the main entrance that leads into an open floor dining room, kitchen, and living room. Licensee states children will eat and nap in the living room. In the dining room, LPAs observed a large dining table, fireplace, and cabinet. Licensee stated she purchased a screen for the fireplace, which will arrive tomorrow. In the kitchen, LPAs observed child safety latches on all cabinet doors. The laundry room is located in between the kitchen and living room. LPAs observed a child safety knob on the laundry room room and a 2A10:BC fire extinguisher inside this room. In the living room, LPAs observed a sofa, coffee table, and TV. Licensee tested the functioning smoke/carbon monoxide detector. The guest house is located in the backyard. LPAs observed secured cubbies with age-appropriate toys, 2 children's tables with chairs, 1 TV, books, cots, 1 crib, and sponge flooring. Licensee tested the functioning smoke/carbon monoxide detector.

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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: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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 4
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: BEN EZRA FAMILY CHILD CARE
FACILITY NUMBER: 197494852
VISIT DATE: 08/19/2021
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Bathroom 3 is located inside the guest house, which includes 1 toilet, 1 sink, and 1 shower. LPAs observed hand washing posters and diapers/wipes in the cabinet underneath the sink.

Indoor Off-Limits
LPAs observed child safety knobs on all bedroom doors and on the door to bathroom 1. Bathroom 2 can only be accessed via bedroom 4. In the guest house, LPAs observed a child safety gate blocking the day care area from the kitchen.

Outdoor
The enclosed backyard is large and includes slides, a secured swing-set, a soccer net, 2 basketball hoops, children's cars, balls, a shaded area with a children's table with chairs for 8 children, and secured cubbies with age-appropriate toys. Licensee stated parents will drop off children at the side gate, which leads to the backyard. The backyard can also be accessed via the sliding door in the living room.

Outdoor Off-Limits
Licensee stated the front yard is off-limits. LPAs observed a gate blocking the utility shut/electrical unit located on the exterior wall of the house in the backyard. The detached garage is made inaccessible by…

Licensee states there are no firearms or weapons of any kind in the facility at the time of the visit. Upon review of child files, LPAs observed all required documents according to Title 22 Regulations. LPAs also observed a First-Aid Kit located kitchen the guest house. All electrical outlets have protective covers.

Corrections (Deadline 8/27/2021, Licensee will email pictures of corrections):
  • Parent board - Licensee will secure a bulletin board with the LIC 610A Emergency Disaster Plan and Notification of Family Child Care (PUB394) in the backyard where it will be visible to parents at drop-off.
  • Fireplace - Licensee will secure a screen/gate to block off the fire place.
  • Cabinet - Licensee will add a child safety latch to the cabinet doors in the living room.



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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: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: BEN EZRA FAMILY CHILD CARE
FACILITY NUMBER: 197494852
VISIT DATE: 08/19/2021
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Discussed topics:

Baby Walkers/etc Prohibited. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucersand any other items that fall into that category. Health & Safety Code 1596.846(b) and (c).

Smoking Prohibited. 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. Health & Safety Code 1596.795(a).

Ratios. Licensee was reminded of the ratios for Large Family Child Care Homes (12 children, no more than 4 infants and 8 children over the age of 2 with a qualified assistant; 14 children, no more than 3 infants and 11 older children, 1 child at least age 6, one enrolled in kindergarten with qualified assistant, landlord permission required and parent notification required).

Shaken Baby Syndrome Awareness & SIDS. Licensee was reminded never shake a baby to prevent Shaken Baby Syndrome. LPA discussed Safe Sleep Regulations with Licensee: one crib or play yard for each infant in care; cribs and play yards are kept free from all loose articles and objects while infants are sleeping; 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 and documents any signs of distress, which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

High Chair & Car Seat Awareness. Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

Parent’s Rights Notification. The "Notification of Parent's Rights" (PUB394) was discussed with the Licensee and the Licensee was advised that it must be posted in an area of the home accessible to parents. Title 22 102419.

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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: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: BEN EZRA FAMILY CHILD CARE
FACILITY NUMBER: 197494852
VISIT DATE: 08/19/2021
NARRATIVE
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Mandated Reporter Required. Licensee was made aware of AB 1207, commencing January 1, 2018, requires all licensed providers, Licensees, 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 Health & Safety Code 1596.8662.

LPAs advised Licensee to follow and remain updated with COVID-19 guidelines.

Criminal Record Clearance. All adults who reside or work in the home must obtain a criminal record clearance or exemption.

Licensing Reports Given to Parents Required. 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. Assembly Bill 633.

Incidental Medical Services Awareness. Incidental Medical Services (IMS) policy was discussed. Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

Forms provided: LIC 311D, LIC 9227 Infant Sleeping Plan, PIN 20-24-CCP.

An exit interview was conducted with the Licensee on 8/19/2021 at 11:45 AM and a copy of this report (LIC809) was provided to the Licensee.

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

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC809 (FAS) - (06/04)
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