198000631-11-13-2023-33-CC-NTCG-CXJQ6U-20231113105407

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198000631
Report Date: 11/13/2023
Date Signed: 11/13/2023 10:54:13 AM

Document Has Been Signed on 11/13/2023 10:54 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	KAKISH, SAMIRA & SAMIR FAMILY DAY CARE		FACILITY NUMBER:	198000631
ADMINISTRATOR:	KAKISH, SAMIRA & SAMIR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 593-9858
CITY:	LA VERNE	STATE: CA	ZIP CODE:	91750
CAPACITY:	14	CENSUS: 0	DATE:	11/13/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Samira Kakish - Licensee		TIME COMPLETED:	11:05 AM

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Licensing Program Analysts (LPAs) Nolan Tcheng and Stephanie Li conducted an unannounced 3-Yr random inspection to the above facility. At 9:10am, LPA met with licensee, Samira Kakish. Also present during this inspection, is Co-Licensee’s Samir Kakish. The licensee states that they currently has 1 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 7am-7pm Monday trough Friday.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, kids room, dining area, living room, attached garage, and backyard (fenced). The children use living room, one bathroom, dining area, kitchen, kids room, and backyard. Per licensee, areas off limits to children and parents include: bedrooms, other bathroom, and attached garage. All areas identified on the facility sketch were inspected. The licensee provides food for children in care.

The licensee states that 2 adults and 0 children currently live in the home. Persons living in home are identified on the attached LIC811. Licensee states that they currently have one assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

At 9:20am, LPA was led on a tour of the facility by the licensee. Upon entry into the home, LPAs reviewed the living room. The dining area is adjacent to the living room and the kitchen. The kitchen was observed to be free of hazards. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. Per licensee, living room will be used as an area for an ill child until an authorized representative comes to pick up child. At 9:25am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 10/14/2023, as indicated on the receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke and carbon monoxide detectors were tested and are operable. The tour continued into the hallway where there is bathroom for children in care to use. Its was observed to be free of hazards.

REPORT CONTINUES PAGE 1 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KAKISH, SAMIRA & SAMIR FAMILY DAY CARE	FACILITY NUMBER: 198000631
	VISIT DATE: 11/13/2023

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LPAs reviewed the kids room next. There were toys and equipment for children in care to use. At this time, Licensee is mainly caring for school age children. The licensee states that there is a land line on the premises. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. LPA observed napping equipment in the form of mats. Equipment is stored in kids room. The kids room has a sliding door that leads to the backyard.

At 9:35am, LPAs observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. The licensee is observed to be operating within the license capacity limitations.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 10/2024. Licensees have not completed mandated reporter training. LPAs discussed with Licensees the requirement needed for all Child Care Providers. An advisory note is being provided. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all information speciﬁed by regulation.

The following was discussed:

-There are no pets on the premises.
-Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

REPORT CONTINUES PAGE 2 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KAKISH, SAMIRA & SAMIR FAMILY DAY CARE	FACILITY NUMBER: 198000631
	VISIT DATE: 11/13/2023

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Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

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

Exit interview conducted and report was reviewed with the licensee Samira Kakish, at 10:45am. Copy of reported

END OF REPORT PAGE 3 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

LIC809 (FAS) - (06/04)

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