300612766-9-18-2019-06-CC-STOE-BG66L7-20190918205352

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300612766
Report Date: 09/18/2019
Date Signed: 09/18/2019 08:54:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	KHOOBAN, YAEL		FACILITY NUMBER:	300612766
ADMINISTRATOR:	KHOOBAN, YAEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 529-9400
CITY:	BREA	STATE: CA	ZIP CODE:	92821
CAPACITY:	14	CENSUS: 4	DATE:	09/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Yael Khooban		TIME COMPLETED:	04:00 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	An unannounced annual inspection was conducted at the facility by Licensing Program Analyst (LPA) Stacy Torrence. LPA met with Yael Kooban, who guided analyst on a tour of the Early Childhood Setting indoors and outdoors. Also present was licensee’s assistant Farazaneh Shalbason. During today’s inspection, there was four napping children present. Licensee has a current children’s roster available. Licensee states that two adults live in the home. Operation hours are 7:30 a.m. to 5:30 p.m.; Monday through Friday. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This is a single-story home which consist of three bedrooms, two and a half bathrooms, living room, kitchen, dining room, garage, front yard (fenced), and back yard (fenced). Licensee stated that OFF LIMITS areas include: the entire front area of licensee's home which is made inaccessible by a gate and the garage. Licensee acknowledged that children may never enter these off-limit areas. The daycare area is located in the back portion of the house; which consist of three rooms. Per Licensee, family enters the daycare on the side of the house; which leads to the back portion of the house. The daycare area was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning supplies, medication, and hazardous items that can pose a danger to children. Per licensee there are no weapons or firearms in the facility. There were age appropriate toys and learning materials. Fire/disaster drill log was reviewed. Outdoor play activity is in the back yard (fenced) and occasionally the front yard(fenced). Licensee stated that she is always present when children are outside playing. The required fire extinguisher (2A10BC), smoke detector, and carbon monoxide detector were in operable condition. First Aid kit was complete. Licensee and assistants do not have a current CPR/First Aid card. Children's records were reviewed.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KHOOBAN, YAEL	FACILITY NUMBER: 300612766
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/18/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/18/2019 Section Cited	1 2 3 4 5 6 7	102416(c) Personnel Requirement. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid...The requirement is not met as evidence by record review of license. Licensee and assistants' CPR/1st Aid have
	8 9 10 11 12 13 14	expired. This poses a potential risk to the safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KHOOBAN, YAEL	FACILITY NUMBER: 300612766
	VISIT DATE: 09/18/2019

NARRATIVE

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Licensee and assistants have proof of immunization against pertussis, measles, and influenza. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. Licensee has not completed the Mandated Reporter Training. Website provided: http://mandatedreporterca.com/. Licensee was informed how/where to access regulations and forms from CCLD website: www.ccld.ca.gov. LPA provided licensee with the Effects of Lead Exposure and Guide to Safe Sleep handouts.

During this inspection, LPA observed the following deficiency and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Sections 102416(c) Personnel Requirements. The deficiency is being cited on the attached LIC 809D. The following Technical Violation is given in accordance with H&S 1596.8662 Mandated Reporter Training.

During this inspection, LPA Torrence cleared previous citations, in which, licensee had proof that the corrections were sent to the previous analyst.

Exit interview was conducted. Report reviewed and discussed with the licensee. Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019

LIC809 (FAS) - (06/04)

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