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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304206660
Report Date: 02/15/2022
Date Signed: 02/15/2022 12:23:38 PM


Document Has Been Signed on 02/15/2022 12:23 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:HASBUN, ELIZABETHFACILITY NUMBER:
304206660
ADMINISTRATOR:HASBUN, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 686-6837
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:14CENSUS: 0DATE:
02/15/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Licensee, Ms. Hasbun, ElizabethTIME COMPLETED:
12:35 PM
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On 02/15/2022, Licensing Program Analyst (LPA), Desai, Ketki conducted an announced case management (other) inspection to place this facility back on active status as it was on inactive status since 08/05/19 . LPA received all the updated documents including the new training documents. Licensee has submitted a new updated application changing the ages of the children to be served. Now plans to serve children ages 1-6 years only and shall continue operations as a Large family child care home. There were no children in care on today's inspection

LPA met with licensee Hasban, Elizabeth who took LPA for a tour of the facility. Present at the time of the inspection was the licensee and the licensee’s husband.

A review of the Facility Personnel Report Summary on 2/15/22 indicates all facility staff or other individuals residing in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility is a single story home. Areas accessible to children in care are the living room, kitchen, dining room, family room and 1 bathroom located on the right side of the hallway. The family room has a fireplace which is locked by a double zip-tie strip. Off limit areas are made inaccessible using locked doors or child proof gates. All sharp utensils and cleaning products in the kitchen are stored up high and are inaccessible to children in care. Poisons/Hazardous items are not stored on site, and none were observed. The licensee acknowledged the children may never enter the off-limit areas which consists of all the three bedrooms, 1 bathroom in the Master bedroom and garage. The licensee has a cell phone that is used for childcare. The licensee was informed if a cell phone is used for childcare, it must always remain on the premises during hours of operation. Licensee was informed and understands the home is to be free from smoking during hours of operation.

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HASBUN, ELIZABETH
FACILITY NUMBER: 304206660
VISIT DATE: 02/15/2022
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The backyard is completed fenced with grass and concrete area for children to engage in outdoor activities, there is a shed with a lock and a fire pit area, which is made inaccessible to children in care by placing a weighed cover. There is a shaded patio area where children shall engage in table top activities. The toys are age appropriate and in good condition for the potential ages served. Baby walkers, bouncers, jumpers, and similar items will not be used for children in care. The licensee stated there no weapons or firearms or pets or bodies of water on the premises. When firearms are present, they must be locked and stored separately from the ammunition. During today's inspection, the smoke detector and carbon monoxide were operable, and the fire extinguisher was charged.

American Red Cross PEDIATRIC CPR & PEDIATRIC First Aid are current for the licensee and expires on 05/3/2023. Mandated Reporter training has been completed on 1/13/2022. Additional immunization records are on file, they are complete.

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

The following was discussed with licensee: Individuals who are 18 years of age or older living or working in the home must be fingerprinted cleared prior to being present in the facility. LPA provided licensee with the website for Live-Scan locations www.oag.ca.gov/fingerprints/locations for all adults complete LIC 9163.

Licensee Ms. Hasban, Elizabeth was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HASBUN, ELIZABETH
FACILITY NUMBER: 304206660
VISIT DATE: 02/15/2022
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LPA reviewed Unusual Incident Report (UIR) form (LIC 624B)-advised to contact Licensing Officer of the Day within 24 hours and complete the UIR within seven days by faxing LIC624B to (714)703-2831. LPA advised licensee to report to licensing any unusual incident or child absence that threatens the physical or emotional health or safety of any child or any changes to hours and days of operation and for any changes to facility, including on/off limit areas and change in phone number.

LPA reviewed with licensee requirements of Disaster Preparedness drills (documented every 6 months).

Department web site form was given to download forms, Title 22 regulations, and training's on-line at http://www.ccld.ca.gov. The licensee was also informed to visit the website for Quarterly Updates. The licensee was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment. A copy of “A Child Care Providers Guild to Safe Sleep” and PIN 20-24-CCP was provided to licensee:

English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf


AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
LPA reviewed with licensee the following safe sleep best practices:
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HASBUN, ELIZABETH
FACILITY NUMBER: 304206660
VISIT DATE: 02/15/2022
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LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Safe Sleep : LPA discussed the safe sleep regulations with Licensee Ms. Hasban, Elizabethand discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA reviewed with Licensee Ms. Hasban, Elizabeth the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Subscribe to CCLD important information

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The facility at the time of Case Management (other)inspection is in compliance for a (Large Family Child Care Home) with Title 22 Regulations.


Facility Inactive status shall be changed to Active status upon Management approval.

Exit interview conducted, Appeal rights were presented and report was reviewed with the Licensee, Ms. Hasban Elizabeth.

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4