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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313745
Report Date: 05/10/2022
Date Signed: 05/10/2022 11:58:36 AM


Document Has Been Signed on 05/10/2022 11:58 AM - 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:SELIAN, HITOMIFACILITY NUMBER:
304313745
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
05/10/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensee Ms. Selian, Hitomi TIME COMPLETED:
12:15 PM
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A Case Management (Licensee initiated) inspection for a change in capacity was conducted at the facility by Licensing Program Analyst (LPA), Desai, Ketki. LPA observed licensee Ms. Selian, Hitomi, with her assistant caring for (4 children and one infant) only. Licensee has been a care provider since April 2020, qualifying her to be a Large Family child care provider. Operating hours: Monday to Friday 6am to 6.00 PM.

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 (3) adults (including the licensee) living in the home.

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to child care children. Off limits areas are made inaccessible by means of child safety gates, installed through the home, at the entrance and exit of the kitchen area. There is a child safety gate installed at the end of the stairway making the second level inaccessible to children. This is a condo home.

Licensee has designated the living area and one half restroom at the end of the hallway along with back patio as part of her day-care. Day care entrance is through main door, leading into the Living area the designated day care room . Adjoining the day care room is the small hallway, the designated children's bathroom is at the end of the hallway opposite the kitchen, it was observed to be clean, no hazardous items were observed. There is cabinet under the sink with drawers and there is a child safety lock installed. Licensee has a small step stool for the younger kids to reach the sink.

Licensee stated the children's primary area is the child care room. There are working carbon monoxide, smoke detector, and fire extinguisher in the home that meet statutory and State Fire Marshall standard . (1)

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022
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: SELIAN, HITOMI
FACILITY NUMBER: 304313745
VISIT DATE: 05/10/2022
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Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored in an area inaccessible to children.

Off Limit areas: Licensee has placed the dining/ kitchen, attached garage, front yard and all second story as off limits and has placed child proof gates, to prevent the children from entering the off-limit areas during operation hours. The facility has an AC/Heater system, unit is installed in the common community area outside the home and inaccessible to children. Facility has a fireplace, in the Day care room with a safe barrier installed across the fire place.



The home has age appropriate Infant and preschool age toys / furniture and activities for children.

Outdoor: Licensee uses the back patio area for activities. It has an emergency exit door with a safety latch on the top. It is completely fenced, with concrete flooring and an awing to provide the shade. Licensee stated they use this area only if needed, most of the activities are held in the living area. Children shall walk through the dining area to access the patio play area.

Licensee stated there are not firearms and/or other dangerous weapons in the facility and none were observed during today's inspections. There are no Bodies of water on the premises.
There is one pet cat in the home, which remains in the off - limit area on the second level.

Children nap in the living room on mats, linens/ blankets were clean and are provided by the parents, and washed by the Licensee as needed. Additional linens are available if needed. All food items are brought from home, Licensee was advised to provide snacks to the children.

The licensee does have a current roster of children in care and 4 records were reviewed on today's inspection , LPA reviewed the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. The licensee and assistant’s Pediatric CPR/First Aid certification is valid through December 2023.



The licensee understands she must be present in the facility, must ensure children in care are supervised at all times, and children are not to be left in parked vehicles. When the licensee is temporarily absent (2)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
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: SELIAN, HITOMI
FACILITY NUMBER: 304313745
VISIT DATE: 05/10/2022
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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, immunization's, Pediatric CPR/First Aid, and mandated reporter training.
Assistant present has met the requirements by completing the required training's and is current on Pediatric CPR & First Aid valid through 01/29/2024.

A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee.

A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

LPA reviewed with 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.

Per Licensee, all infants shall nap in the Day care room in the cribs, she and the assistant remain in the Day care area, checks on them every 15 minutes and they not left unattended in this room. Licensee has a changing mat, all infants needed items, Diapers/ formula/ mother's milk and lotions are provided by the parents.

OTHER INFORMATION AND FORMS PROVIDED:
Capacity Handout for a Large Family Child Care Home was provided and LIC 9150 was reviewed with the Licensee (3)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
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: SELIAN, HITOMI
FACILITY NUMBER: 304313745
VISIT DATE: 05/10/2022
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Fire inspection from Orange County Fire Authority Fire inspection services have granted the fire clearance with specific instruction where garage and the second level is not permitted for Day care.

The licensee does have a current roster of children in care. Facility files and four children files were reviewed and meets the requirements. Fire drills are held quarterly and records are maintained.

LPA discussed the following items with the applicant Ms. Selian, Hitomi during the Exit interview:

Criminal Record statement: Facility Representative Ms. Selian, Hitomi was reminded that all adults 18 and over living or working in the home, 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.

Safe Sleep : LPA discussed the safe sleep regulations with Facility Licensee Ms. Selian, Hitomi & 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 the Facility Representative Ms. Selian, Hitomi 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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.



Review of records to be maintained : LPA reviewed with Facility Representative 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. (4)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
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: SELIAN, HITOMI
FACILITY NUMBER: 304313745
VISIT DATE: 05/10/2022
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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.

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 license-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 was complying with Title 22 Regulations at the time of inspection.

A license with the change in capacity for 14 children (Large Family Child care home) will be issued after final review, in the event additional requirements are needed, Licensee will be notified.


On today’s inspection each child was observed to have a safe, healthful and comfortable accommodation furnishing and equipment’s.

Appeal rights were presented along with this report to the Licensee.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC809 (FAS) - (06/04)
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