198017496-9-25-2019-33-CC-AEIN-BGCSX8-20190925141530

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017496
Report Date: 09/25/2019
Date Signed: 09/25/2019 02:15:37 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:	EBRAHIMI FAMILY CHILD CARE		FACILITY NUMBER:	198017496
ADMINISTRATOR:	EBRAHIMI, GLADYS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 500-8983
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91206
CAPACITY:	14	CENSUS: 11	DATE:	09/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:01 PM
MET WITH:	Gladys Ebrahimi, Licensee		TIME COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	ANNUAL/RANDOM INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced random inspection. LPA met with licensee, Gladys Ebrahimi who guided analyst on a tour of the facility. Also present were Edna Aslanian and Lidoush Issaian, licensee's assistants. There were 11 children present during this inspection, two being infants. Ms. Ebrahimi states that there are currently 12 children enrolled, children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted 08/18/19. This is a one story home which consists of 3 bedrooms, 3 bathrooms, kitchen, child care room, dining room, living room (FIREPLACE: which is inaccessible and disconnected), laundry room, garage (storage), front yard, and backyard (fenced). The children use the bathroom in the hallway, child care room, dining room, living room, kitchen, and backyard (fenced). Per licensee, areas off limits to children and parents include: 3 bedrooms, 2 bathrooms, laundry room, front yard, and garage (storage). The LPA toured all areas used by children during this inspection. Family members residing in the home are 2 adults who have clearances on file and 2 children. Licensee provides breakfast, AM and PM snacks, and lunch in a family style. All areas used by children were inspected for safety, comfort, cleanliness, telephone, ventilation and heating (central). The licensee states that there are no poisons in the home. The licensee understands that any poisons must be locked with a key or combination lock. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in some areas in the home. Per licensee, there are no pets, weapons, firearms or bodies of water on the premises. There were toys observed for children. Posting requirements were observed to be posted at the time of inspection. REPORT CONTINUES ON NEXT PAGE 1 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

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 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: EBRAHIMI FAMILY CHILD CARE	FACILITY NUMBER: 198017496
	VISIT DATE: 09/25/2019

NARRATIVE

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Per licensee, she does carry liability insurance for 3 millions with standard established by Family Child Care statue. Signed statements (LIC282) on file. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the singed statement in the facility file.

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
LPA advised the licensee how to access forms, regulations and quarterly updates, and provider information notices (PIN) on line at: www.ccld.ca.gov

LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.

LPA issued the Confidential Names List (LIC 811) to the licensee during this inspection. The Confidential Names List documents the children’s files that were reviewed during this inspection.

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.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview was conducted with Gladys Ebrahimi, Licensee. Appeal rights explained & provided.

REPORT END 3 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

LIC809 (FAS) - (06/04)

Page: 3 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: EBRAHIMI FAMILY CHILD CARE	FACILITY NUMBER: 198017496
	VISIT DATE: 09/25/2019

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Children’s records were reviewed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 09/18/19, as indicated on service tag. Smoke and carbon monoxide detectors were tested, and are in operable condition. There are emergency supplies on the premises.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations. All adults present have obtained a criminal record clearance. The licensee has proof of current pediatric first aid and CPR (expires: 11/20/2020). Licensee and her assistants completed required mandated reporter training, certificates on file. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

The following was discussed:

INFANT CARE: Licensee states that she does care for infants. LPA discussed the licensee’s plan for supervising sleeping infants. Licensee states the following: Any infants in care will stay in the area where the licensee or assistant are. LPA advised the licensee to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. The licensee states that she will not sleep infants in a separate room. Per Licensee, infants sleep in daycare room in crib. 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. Safe sleep concepts were provided.

Medication: 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

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.

REPORT CONTINUES ON NEXT PAGE 2 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

LIC809 (FAS) - (06/04)

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