198018465-10-5-2022-54-CC-WBIS-CJWPGL-20221005111830

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018465
Report Date: 10/05/2022
Date Signed: 10/05/2022 11:18:38 AM

Document Has Been Signed on 10/05/2022 11:18 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	SAMIA FAMILY CHILD CARE		FACILITY NUMBER:	198018465
ADMINISTRATOR:	HAIDEE SAMIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 496-8306
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY:	14	CENSUS: 5	DATE:	10/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	Haidee Samai		TIME COMPLETED:	11:30 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	Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required - 1 Year inspection. LPA met with Licensee Haidee Samia who guided LPA on a tour of the facility. Upon arrival, LPA observed the Licensee was providing care for five preschool children. There are currently five children enrolled. LPA also observed one adult resident assisting with care. Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption.. At Approximately 8:50am LPA conducted an inspection of all areas of the facility sketch. This is a two story home which consists four bedrooms and five bathrooms. Areas used by the children include the living room, family room, two bedrooms, one bathroom, and backyard. Per Licensee areas off limits to children and parents are all upstairs bedrooms, upstairs bathrooms and the garage. LPA informed Licensee to contact the department if she intends on using other areas of the home and to always ensure that hazards remain inaccessible. LPA also informed Licensee to ensure children have visual supervision for care that may be done away from the facility (for example at a park or field trip). Areas accessible to children were inspected to ensure they are clean and orderly with ventilation and heating for the safety of the children. There is a working phone maintained in the home. Between 8:50am and 9:10am LPA observed age appropriate toys and play equipment inside the home and in the backyard. There is a child gate installed on the stairwell to prevent children under five from having access to upstairs. LPA observed the backyard is surrounded by fencing at least 5 feet high. There is a detached garage in the backyard that remains locked and inaccessible. Per Licensee, there is no parking in the backyard driveway and no pets. LPA advised Licensee to provide extra care and supervision if she ever has pets (as pets can be unpredictable). LPA observed detergents, cleaning compounds, medications, and other items which can pose a danger to children to be inaccessible (in locked cabinets or areas inaccessible to children). LPA informed Licensee that poisons must be locked with a key or combination lock.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SAMIA FAMILY CHILD CARE	FACILITY NUMBER: 198018465
	VISIT DATE: 10/05/2022

NARRATIVE

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Per Licensee there are no firearms, weapons or bodies of water and LPA did not observe any on the premises. The License, Parents Rights Poster, and Earthquake Preparedness was posted. The valve on the required 2A 10BC fire extinguisher indicates fully charged and is due for service August 15, 2023. Smoke and carbon monoxide detectors in the family room were tested and are in operable condition. The children's roster and the Disaster drill is current (last date of drill June 24, 2022. LPA observed the Licensee and staff have the current Mandated Reporter training which expires April 28, 2023. LPA observed the Licensee also has documentation indicating immunization regarding measles, pertussis and tuberculosis on file.

LPA reviewed five children's files which include the documentation such as: Parent's Rights, Personal, Affidavit for Liability insurance, Identification and Emergency, Consent for Emergency Treatment, Additional Children in Care and Immunization records. Note: Safe Sleep form 9227 and Safe Sleep log is not required as the Licensee has no infants enrolled at this time. The Licensee indicated she has the Safe Sleep forms ready if she ever enrolls infants.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty. LPA advised to ensure all adults that come into the home are fingerprint cleared and associated.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present. Licensee's CPR expires September March 2024

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

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SAMIA FAMILY CHILD CARE	FACILITY NUMBER: 198018465
	VISIT DATE: 10/05/2022

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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 document the child's condition. The LIC 9227 Individual Infant Sleeping The plan shall be completed for each infant up to 12 months of age. LPA provided a form and explained that the form is available on CCLD website.

The Licensee was advised on the inaccessibility of hazards, Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA informed Licensee regarding PIN 20-24-CCP. LPA discussed LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. 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). Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com. Licensee and staff have the required Mandated Reporter training.

LPA informed Licensee and assistant regarding with Safe Sleep PIN 20-24-CCP LPA also discussed Entrance Checklist form, Capacity and Ratio, and Items not Permitted. LPA explained these regulations and advised Licensee to ensure that she provides care and supervision adhering to the information provided.

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. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Haidee Samia.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

LIC809 (FAS) - (06/04)

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