304311783-5-20-2019-06-CC-STOE-BCCS32-20190520133024

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304311783
Report Date: 05/20/2019
Date Signed: 05/20/2019 01:30:29 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:	HAROUN, HANAN		FACILITY NUMBER:	304311783
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	6	CENSUS: 3	DATE:	05/20/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	11:57 AM
MET WITH:	Hanan Haroun		TIME COMPLETED:	01:35 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 inspection was conducted at the facility by Licensing Program Analyst (LPA) Stacy Torrence. 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. According to licensee, there are presently two adults and two children living in the home. During today’s inspection the home was toured, and the licensee was operating within the licensed capacity. Present during today's inspection was the Licensee, Hanan Haroun. There were three children present today. LPA observed the three children resting on their mats. Licensee currently have six children enrolled. Current children’s roster was available. This is a one-story home which consists of four bedrooms, two bathrooms, living room(Fireplace; barricaded; inaccessible to children), kitchen, front yard (fenced), back yard(fenced), and garage. The floor plan was verified. Off limit areas include: kitchen, three bedrooms, one bathroom, front yard (fenced), and garage. The main day care areas are the living room and one bedroom. The licensee's pediatric CPR/First Aid certification are current. Items which could pose a danger to children were not accessible to children. Poisonous items were not observed during today's inspection. The smoke detector and carbon monoxide were tested and are operable. Fire extinguisher is fully charged. Emergency Disaster drill log within the past six months was available. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit. Children's records: parents' rights and California School Immunization Record were reviewed. Incidental Medical Services-IMS was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. 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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

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 2

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: HAROUN, HANAN	FACILITY NUMBER: 304311783
	VISIT DATE: 05/20/2019

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
26
27
28
29
30
31
32

Licensee had 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
A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” and a copy of the Safe Sleep policy were provided to the licensee.
AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/. LPA discussed the mandated reporter training policy with licensee and demonstrated how to get on the website and complete the exam. LPA also advised Licensee that she will need to send a copy of the certification to the Department. An Advisory Note was given to the Licensee for the mandated reporter training.

Licensee was informed how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

There was no deficiency cited per CA Code of Regulations Title 22.

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.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2