304313542-2-8-2024-06-CC-VTRH-D29VGY-20240208152619

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313542
Report Date: 02/08/2024
Date Signed: 02/08/2024 03:26:40 PM

Document Has Been Signed on 02/08/2024 03:26 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	SUFI-ISMAIL, MARYAM		FACILITY NUMBER:	304313542
ADMINISTRATOR:	SUFI-ISMAIL, MARYAM & ASLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	7148151468
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY:	14	CENSUS: 13	DATE:	02/08/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Suri-Ismail, Maryam & Asla (Licensees)		TIME COMPLETED:	03:45 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	On February 8, 2024 an unannounced 3 year inspection was conducted at the facility by Licensing Program Analyst (LPA) V. Trinh. At 12:40 PM observed licensee and 2 assistants Fathima Shiham and Maisaa Sbini , caring for total 13 of children, which included Zero infants, 3 preschool and 10 school age/ Kindergarten children . The licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 6 adults including the licensee and 4 minor children living in the facility. Facility Day care hours are 9am-3pm, Monday through Thursday. During today’s inspection, LPA and licensee toured the inside and outside areas of the facility sketch LIC 999A as accessible to childcare children. This is a single-family home, with 4 bedrooms and 3 bathrooms. Off-limits areas are made inaccessible by means of baby gates. Licensee stated that OFF LIMITS areas include: all bedrooms, garage, front yard, and kitchen. The licensee acknowledged that children may never enter these off-limit areas. The childcare area consists of the studio room and living room, dining room, and backyard, which is accessed through the side gate and the laundry room. The children walk through the mudroom from the front door to the children bathroom. The licensee stated the children's primary area is the studio room, living room, and dining room, and backyard. LPA inspection of the living room and dining room are safe and sanitary and can be used for childcare areas. Continued Page 2

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Vivian Trinh	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SUFI-ISMAIL, MARYAM	FACILITY NUMBER: 304313542
	VISIT DATE: 02/08/2024

NARRATIVE

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OUTDOOR INSPECTION: The playground was enclosed by a fence. The outdoor equipment and toys were in good repair and free of sharp edges. At the time of inspection, the surface of the outdoor activity area was well-maintained and free of any observable hazards. Children will not be able to have outside play in the enclosed backyard due to construction. During today's inspection, each child was observed to have safe, healthful, and comfortable accommodations, furnishings, and equipment. There were no bodies of water in the facility at the time of inspection.

There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. There were no poisons or other items observed which could pose a danger to children or if they were observed, they were locked or inaccessible. Licensee stated there are not firearms or other dangerous weapons in the facility and none were observed during today's inspections. There is a fireplace in the studio room cover by metal screened and inaccessible to children in care. The home has age-appropriate toys for the ages served. LPA verified there is a working telephone service (cellular service), licensee was reminded that childcare phone needs to remain the in the childcare at all times. Licensee stated they use the backyard for outdoor play.

The licensee does have a current roster of children in care. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700), Immunization records, Affidavit Regarding Liability Insurance (LIC282), Consent for Emergency Medical Treatment (LIC627), Notification of Parent’s Rights (LIC995A) and found to be in compliance. Licensee stated, there is Zero infant under 24 months enrolled in the childcare. LPA reviewed LIC 9227 Individual Infant Sleeping Plan and napping log for infants.

The licensee and 2 assistant’s Pediatric CPR/First Aid certification expired 8/2025. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family childcare home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for licensee and 2 assistants were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years.
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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Vivian Trinh	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SUFI-ISMAIL, MARYAM	FACILITY NUMBER: 304313542
	VISIT DATE: 02/08/2024

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/

The licensee understands she must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

CCLD website www.cdss.ca.gov/inforesources/community-care-licensing was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee.

LPA discussed the safe sleep regulations with licensee and 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 licensee [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.
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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Vivian Trinh	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SUFI-ISMAIL, MARYAM	FACILITY NUMBER: 304313542
	VISIT DATE: 02/08/2024

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

In the areas that were evaluated, NO deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the licensee . A notice of site visit was given and must remain posted for 30 days.

During the exit interview, the licensee, Sufi Ismail, Maryam, confirmed that there are no Registered Sex
Offenders living in the facility and LPA completed the RSO profile in FAS.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
End of Report.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Vivian Trinh	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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