198017496-11-4-2022-33-CC-AEIN-CKUT6T-20221104142741

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017496
Report Date: 11/04/2022
Date Signed: 11/04/2022 02:27:50 PM

Document Has Been Signed on 11/04/2022 02:27 PM - It Cannot Be Edited

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:	11/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Gladys Ebrahimi, Licensee		TIME COMPLETED:	02:45 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 INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual inspection to the above facility on 11/14/2022. LPA arrived at the facility at 11:30 AM and met with Gladys Ebrahimi, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was Vartan Baroni, Licensee’s Assistant/husband. Per licensee, Gladys Ebrahimi facility hours are Monday to Friday from 7:00 a.m. to 6:00 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee. Per licensee, she is affiliated with Pacific Clinic Head Start Program. This is a one story home located on the first level which consists of 3 bedrooms, 2 & 1/2 bathrooms, kitchen, child care room, dining room, living room, laundry room, garage (storage), front yard, and backyard (fenced). The children use the bathroom in the hallway of bedrooms, child care room, dining room, living room, kitchen, and backyard (fenced). Per licensee, areas off limits to children and parents include: 3 bedrooms, 1 & 1/2 bathrooms, laundry room, front yard, and garage (storage). LPA did not observe any stairs in the home during this inspection. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 11:50 a.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the daycare room, LPA observed children tables, chairs, toys, and napping beds in daycare area. LPA observed all electrical outlets were covered in daycare room. Next LPA toured the kitchen and observed sharp items and knives where placed in a high level cabinet out of reach of children. Next LPA toured the dining room and observed a dining table and chairs in the dining room. Next LPA toured the living room and observed sofas and a coffee table in the living room. There is a fireplace in living room which is screened, inaccessible and disconnected. Next LPA toured the bathroom in the hallway of bedrooms and did not observe any hazards. LPA observed off-limit areas doors where closed during this inspection. REPORT CONTINUES ON NEXT PAGE 1 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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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: 11/04/2022

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LPA observed the required 2A 10BC fire extinguisher was anchored to the wall by the laundry room. It was purchased on 05/20/22 as read by LPA from the tag. Licensee tested the carbon monoxide detector in the kitchen and smoke detector in the daycare room. Both sounded off the alarms and heard by LPA to be functional. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. 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.

Next LPA toured the backyard fenced. Currently, children are using the back yard for outdoor play time. LPA observed 11 children were playing outside with licensee and her husband. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided.

Per Licensee, at 12:10 p.m. there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises. There are three birds on the premises that kept in the cage.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she has one assistant. 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.

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 11/2022. Licensee, completed required mandated reporter training on 03/13/2022. There are first aid supplies available on the premises in the daycare room. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

REPORT CONTINUES ON NEXT PAGE 2 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

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

FACILITY NAME: EBRAHIMI FAMILY CHILD CARE	FACILITY NUMBER: 198017496
	VISIT DATE: 11/04/2022

NARRATIVE

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At 12:30 p.m., facility roster was reviewed and completed. Per licensee currently there are 12 children enrolled. LPA reviewed 5 children's records, including emergency information from 12 enrolled children, and all 5 reviewed files were completed.

The licensee and her assistant have proof of immunization against influenza, pertussis, and measles. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 10/11/2022. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. There is telephone service via a landline that is used and stays at the facility during operation hours. Per licensee she carries liability insurance in accordance with standard established by Family Child Care statue.

INFANT CARE: Licensee states that she is provides care to infants over one years old. Per licensee, currently she has two infants enrolled in her daycare that are close to two years old. Licensee states that infants sleep in the daycare room where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. (one crib for each infant under 12 months old is required). Cribs or play yard shall not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

REPORT CONTINUES ON NEXT PAGE 3 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

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

FACILITY NAME: EBRAHIMI FAMILY CHILD CARE	FACILITY NUMBER: 198017496
	VISIT DATE: 11/04/2022

NARRATIVE

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SAFE SLEEP: LPA discussed the safe sleep regulations with licensee, and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/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 http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Boppy recall: https://www.cpsc.gov/Recalls/2021/The-Boppy-Company-Recalls-Over-3-Million-Original-Newborn-Loungers-Boppy-Preferred-Newborn-Loungers-and-Pottery-Barn-Kids-Boppy-Newborn-Loungers-After-8-Infant-Deaths-Suffocation-Risk
Medication: Incidental Medical Services (IMS) policy was discussed. The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today.
The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
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 experienced. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding inspection tools and methods, please visit the Program website at www.cdss.gov/inforesouces/community-care-liceinsing/inspection-process
Exit interview conducted and report was reviewed with the Licensee, Gladys Ebrahimi at 2:45 p.m..

REPORT END 4 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

LIC809 (FAS) - (06/04)

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