304312883-2-4-2021-06-CC-JHAN-BY2SY6-20210208131659

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304312883
Report Date: 02/04/2021
Date Signed: 02/04/2021 09:35:08 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/03/2020 and conducted by Evaluator Carmen Odom

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20201103121804

FACILITY NAME:	KHAMIS, NAJWA JOSEPH		FACILITY NUMBER:	304312883
ADMINISTRATOR:	KHAMIS, NAJWA JOSEPH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 313-5655
CITY:	CYPRESS	STATE: CA	ZIP CODE:	90630
CAPACITY:	14	CENSUS: 2	DATE:	02/04/2021
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Licensee - Najwa Khamis		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Over Capacity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Odom and Leonor Barajas conducted an unannounced complaint inspection to deliver the complaint findings. This is a continuation of the investigation initiated on 11/03/2020. Upon arrival LPA met with Licensee Najwa Khamis, who guided LPA on a tour of the facility. LPA observed 1 Infant, and 1 preschool age children in the childcare. During today’s inspection the facility was operating within its licensed capacity and within compliance of staffing ratios.
A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The Department received a complaint on 11/03/2020 alleging facility operated over capacity for the month of August and possibly September. The 16 children were together from 10:00am to 5:00pm during the month of August.

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen Odom	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2021

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

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20201103121804

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: KHAMIS, NAJWA JOSEPH	FACILITY NUMBER: 304312883
	VISIT DATE: 02/04/2021

NARRATIVE

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During the investigation LPA Odom interviewed Complainant Party, licensee, 1 staff member, 8 parents, obtained children’s roster and children’s attendance records.

On 11/09/2020, Complainant Party provided 17 children’s attendance sheets for the month of August 2020 and 18 children’s attendance sheets for the month of September 2020. During the month of August Licensee recorded on the children’s attendance sheets that 16 children were in the childcare throughout the month of August, the weeks of 08/03/20 to 08/07/20, 08/10/20 to 08/14/20, 08/17/20 to 08/21/20, and 08/24/20 to 08/28/20 from the hours of 1:00pm to 5:00pm all at the same time. Also, the following the month Licensee recorded on the children’s attendance sheets that 15 children were in the childcare throughout the month of September, the weeks of 09/01/20 to 09/04/20, 09/08/20; to 09/11/20, 09/14/20 to 09/18/20, 09/21/20 to 09/25/20, and 09/25/20 to 09/30/20 from the hours of 1:00pm to 5:00pm all at the same time.

During an interview on 11/10/2020, Licensee stated, I usually have 10 to 12 children in the childcare. The hours of operation are Monday to Saturday, 23 hours a day with 1 assistant. When asked, about over capacity and ratio, Licensee stated, Yes, I know about over capacity and ratio.

Eight parents were interviewed on 01/22/21, 01/25/21, and 01/27/21 all the parents disclosed they have never seen more than 14 children in the childcare at the same time. Parent #6 stated, there have been a few times Licensee was at full capacity, but I have not seen more than 14 children at the childcare.

Based on LPA’s observation and interviews which were conducted, and records reviewed, the facility failed to comply with staffing/ratio requirements. This requirement was not met as evidenced by exceeding maximum capacity of large family childcare home. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Chapter 1, Article 6. Section 102416.5(d)(1) are being cited on the attached deficiencies page.

This report cites a Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen Odom	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2021

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20201103121804

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: KHAMIS, NAJWA JOSEPH	FACILITY NUMBER: 304312883
	VISIT DATE: 02/04/2021

NARRATIVE

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An exit interview was conducted with Licensee Najwa Khamis. A Notice of Site Visit was posted during the visit. Licensee 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. Licensee was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights.

End of Report

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen Odom	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2021

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20201103121804

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: KHAMIS, NAJWA JOSEPH	FACILITY NUMBER: 304312883
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/04/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/04/2021 Section Cited CCR 102416.5(d)(1)	1 2 3 4 5 6 7	102416.5(d)(1) Staffing ratio and capacity (d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time..., shall be either:(1) Twelve children, no more than four of whom may be infants; or This Requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated 5 children have left from the month of November to January. Licensee will ensure to always have an assistant present. Licensee will write a statement on plan of correction and provide it to the licensing office by 2/4/21.
	8 9 10 11 12 13 14	Based on interviews and records reviewed licensee failed to stay within childcare capacity for a large family childcare home. Licensee was over-capacity for the month of August 2020 and September 2020. This imposes an immediate health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen Odom	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2021

LIC9099 (FAS) - (06/04)

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