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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313437
Report Date: 07/17/2019
Date Signed: 07/17/2019 11:38:50 AM

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:BILTAR, JOHANNA & SULEIMAN, OSAMAFACILITY NUMBER:
304313437
ADMINISTRATOR:BILTAR, JOHAN. & SUL. OSAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
9499566571
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY:14CENSUS: 8DATE:
07/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Licensee, Biltar JohannaTIME COMPLETED:
12:15 PM
NARRATIVE
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An unannounced Random/Annual visit was conducted today by Licensing Program Analyst (LPA) Nguyen. Met with licensee's assistant Turner Lauryn who stated that licensee is dropping her child off and will be back soon. Licensee, Biltar Johanna arrived 20 minutes after LPA arrival. Present at the time of the inspection was the licensee’s mother, licensee’s assistant and 8 day care children, 4 of which were under the age of two years. A review of adults living or working in the home on this date indicated individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The home is a one story with 3 bedrooms and 3 bathrooms. Licensee designated the following areas of the home for the care and supervision of children: daycare room, hallway bathroom, and enclosed backyard. OFF LIMIT areas include: all 3 bedrooms, kitchen, garage, and side yard. Licensee acknowledge that children are never to enter an off-limit area of the home. LPA observed a gate at the entrance of the dining room and the daycare room. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medication, and hazardous items that could pose a danger to children. Fire drill log, children's records and rosters were reviewed on today's inspection. Children's records for the children present during LPA's inspection were reviewed for: Immunization and updates records, and a signed copy of the Family Child Care Home Notification of Parents’ Rights. During today's inspection, one of the eight children's files reviewed did not have documentation of immunization.

Licensee stated there are no firearms on the premises. LPA advised anytime when firearms are present, they must be locked and stored separately from the ammunition. No swimming pool, spa or other bodies of water observed on the premises. There are age appropriate toys and equipment on the premises for the ages served. The required fire extinguisher (2A10BC), carbon monoxide, and smoke detectors are in operable condition. LPA observed CPR & First Aid (exp. 6/04/21 & 5/11/21) are current for the licensee’s assistant Turner Lauryn. Continued Page 2
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
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 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: BILTAR, JOHANNA & SULEIMAN, OSAMA
FACILITY NUMBER: 304313437
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2019
Section Cited
CCR
102418(g)
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102418(g) Immunizations (g)The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
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Licensee will submit proof to LPA by 07/31/19 by mailing to the office.
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Based on record reviews 1 out of 8 children have no immunization records and blue immunization cards. This poses a potential Health and Safety risk to the children in care
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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 HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
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: BILTAR, JOHANNA & SULEIMAN, OSAMA
FACILITY NUMBER: 304313437
VISIT DATE: 07/17/2019
NARRATIVE
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Based on LPA observations and record reviews the following violation was observed is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 102418(g) is being cited on the attached LIC 809D.

Exit interview was conducted. Report reviewed and discussed with the licensee. “The licensee was provided a copy of their appeal rights (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights.” Notice of Site Visit was posted. Licensee was informed to keep the Notice of Site Visit posted for 30 days during the day care hours or $100 civil penalty will be assessed. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 4 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: BILTAR, JOHANNA & SULEIMAN, OSAMA
FACILITY NUMBER: 304313437
VISIT DATE: 07/17/2019
NARRATIVE
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Current immunization information for pertussis, measles, influenza, and mandated reporter training were verified by LPA.

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 were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to presence in the facility. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No Johnny jumpers, No exersaucer or any other similar items that fall into that category are allowed in the facility. Disaster drills, posting requirements, children record, mandated child abuse and injury/ death reporting, and criminal records clearances/exemption transfer requests. Providers guide to Safe Sleep, Never Shake a Baby, Ratio and Capacity, 25 E-learning Modules, Lead exposure information, and California Child Passenger Safety Law. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf. The below links offer more information on safe sleep to our providers https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx. https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

The licensee was also informed to visit the www.ccld.ca.gov website for Quarterly Updates. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov

Continued on Page 3

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4