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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009841
Report Date: 05/24/2019
Date Signed: 05/24/2019 04:58:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ALSOUROUGI FAMILY CHILD CAREFACILITY NUMBER:
198009841
ADMINISTRATOR:ALSOUROUGI, JOSEFINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 413-2209
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:14CENSUS: 14DATE:
05/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Josefina AlsourougiTIME COMPLETED:
05:15 PM
NARRATIVE
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A RANDOM INSPECTION CONDUCTED IN ENGLISH
Licensing Program Analysts (LPAs), Lissete Gonzalez and Ariel Cazares conducted an unannounced annual random site inspection to ensure the health & safety standards as required by regulations governing family child care homes. Upon arrival, LPAs met with Licensee, Josefina Alsourougi and toured the facility indoors and outdoors. There were 14 children present (3 infants, 10 preschool age, and 1 school age) along with one assistant. Individuals residing in the home are the licensee and the licensee’s spouse. Licensee’s operating hours are from 7:00 a.m. to 6:00 p.m. from Monday through Friday.

This is a one story home which consists of 2 bedrooms, 1 day care room, 3 bathrooms, kitchen, dining room, living room, detached room in the back yard, front yard (fenced), and backyard (fenced). The children use the bathroom in the hallway, living room, day care room, exterior bathroom (supervised) and front yard (fenced). Per licensee, areas off limits to children and parents include: 2 bedrooms, 1 bathroom, family room, dining room, kitchen, detached room, and backyard (fenced). There is door in the living room which was observed to be closed to prevent access to the off limit areas. Licensee has the Parent’s Rights poster and other appropriate forms posted on wall in the day care room. Licensee’s First Aid/Infant CPR certificates are valid through 02/2020. Licensee has not completed the mandated reporter training. Licensee's disaster drill log notes last drill conducted on 05/06/19. Licensee has a working telephone.

LPAs observed the 2A10BC fire extinguisher located in the kitchen was last serviced on 8/16/2018 and is fully charged. There is an operational smoke detector and an operational carbon monoxide detector in the home. There is central air and heating available in the home.

REPORT CONTINUES ON THE NEXT PAGE 1 OF 3

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
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 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ALSOUROUGI FAMILY CHILD CARE
FACILITY NUMBER: 198009841
VISIT DATE: 05/24/2019
NARRATIVE
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A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home.

Based on this information, the following deficiencies listed on the attached LIC 809d are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Whenever a type A is cited: “Upon receipt, 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.”

LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee, Josephina Alsourougi. Appeal rights discussed and explained.

*END OF REPORT PAGE 3 OF 3

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ALSOUROUGI FAMILY CHILD CARE
FACILITY NUMBER: 198009841
VISIT DATE: 05/24/2019
NARRATIVE
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LPAs observed the children’s day care room to be organized. No hazards or violations were observed. The living room used by the children was inspected. No hazards or violations were observed. The home has electrical outlet covers throughout and maintains a First Aid Kit. There are adequate age appropriate toys, books, and games. There are no firearms present on the premises as stated by licensee. LPAs inspected the front yard. LPAs observed age appropriate toys and there is shade available. Currently there is one dog.

There is a in ground pool located in the back yard. The pool is surrounded by a 5” foot pool fence and a wall. During this inspection LPAs observed two gates that surround the pool that swing away and are self-latching with locks (unlocked) further securing the gates. The fence meets Title 22 Regulations.

Children's Roster and Staff files were reviewed and found to be outdated or incomplete. Children’s files were found to be incomplete as there were two missing files for C13 and C14. Based on files and information obtained, licensee was out of ratio as there was only 1 school age child out of the 14 present. Diagram of staff-ratios was provided to licensee.

The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPAs discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.

LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Copy of safe sleep concepts was provided.



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

REPORT CONTINUES ON THE NEXT PAGE 2 OF 3
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ALSOUROUGI FAMILY CHILD CARE
FACILITY NUMBER: 198009841
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
HSC
1596.8662(c)
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Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion
Current proof of completion for each licensed child care provider or applicant
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Per licensee, she will complete the mandated reporter training by next Friday. Proof of completion will be submitted to LPA.
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for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department. This requirement was not met as evidenced by: Licensee did not proof of Mandated Reporter completion. This poses a potential risk to the health and safety
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of the children in care.
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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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
LIC809 (FAS) - (06/04)
Page: 6 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ALSOUROUGI FAMILY CHILD CARE
FACILITY NUMBER: 198009841
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
CCR
102417(g)(8)
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Operation of a Family Child Care Home

The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
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Per Licensee, the roster will be updated immediately and an updated copy of the roster will be submitted to LPA.
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This requirement was not met as evidenced by: The facility roster was not current. This poses a potential risk to the health and safety of the children in care.
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Type B
05/31/2019
Section Cited
CCR
102421
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Child's Records

This requirement was not met as evidenced by: C13 and C14 did not have files at the facility. This poses a potential risk to the health and safety of teh children in care.
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Per Licensee, she will submit a statement acknowledging children's files need to be maintained for every child in care.
Type B
05/31/2019
Section Cited
HSC
1597.622
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Employee and Volunteer Immunization

This requirement was not met as evidenced by: S1 is missing proof of pertussis vaccine. This poses a potential risk to the health and safety of the children in care.
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Per Licensee, she will submit proof of the pertussis immunization for S1.
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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ALSOUROUGI FAMILY CHILD CARE
FACILITY NUMBER: 198009841
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2019
Section Cited
HSC
1597.465(a)
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Large family day care homes; number of children

A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met:
(a) At least one child is enrolled in and
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Per Licensee, C14 was on a trial. Licensee stated she will not be enrolled. Licensee will submit a written statement to LPA.
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attending kindergarten or elementary school and a second child is at least six years of age. This requirement was not met as evidened by: Licensee has 14 children present which include 3 infants, 10 preschool age, and 1 school age. This poses and immediate risk to the health and safety of the children in care.
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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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
LIC809 (FAS) - (06/04)
Page: 4 of 6