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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411218
Report Date: 03/19/2025
Date Signed: 03/19/2025 02:34:11 PM

Document Has Been Signed on 03/19/2025 02:34 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MIRZA FAMILY CHILD CAREFACILITY NUMBER:
197411218
ADMINISTRATOR/
DIRECTOR:		MIRZA, MUMTAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 838-1649
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 5DATE:
03/19/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:MUMTAZ MIRZA, LICENSEETIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 03/19/2025, Licensing Program Analyst (LPA) Lisa Clayton made an unannounced visit to the Mirza Family Child Care Home to conduct the Required 3-year inspection. LPA was greeted by Licensee Mumtaz Mirza. LPA Clayton observed 5 children in care, being supervised by Licensee and her fingerprint cleared husband. Per Licensee the hours of operation are Monday through Friday. 8am – 5pm. Licensee provides morning and afternoon snacks, lunch, dinner and water.

LPA toured the entire home inside and outside for a Health and Safety inspection. The home is neat and clean and has ventilation for safety and comfort. The home has working telephone and LPA Clayton confirmed the number is (310) 838- 1649.

LPA Clayton confirmed that the home consists of: living room, dining room, kitchen, 3 bedrooms, 2 bathrooms, laundry room, attached garage and fenced front and back yard.

The ON LIMIT AREAS are as follows: living room (main daycare area), dining room, bathroom #1, bedroom #2 (infant nap area), bedroom #3, and fenced front yard. The isolation area is in the dining room.

The OFF-LIMIT AREAS are as follows: bedroom #1, and bathroom #2, kitchen, attached garage and fenced back yard, all of which are inaccessible to children in care by closed and/or locked doors and visual supervision.

Furniture and equipment in the home are in good condition and free of sharp, loose, or pointed parts.

There are no pools, ponds, spas, or any other bodies of water on the property. There are no firearms or ammunition on the property.


SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MIRZA FAMILY CHILD CARE
FACILITY NUMBER: 197411218
VISIT DATE: 03/19/2025
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The home has a fully charged 1A40BC fire extinguisher in the kitchen, and a working smoke detector/carbon monoxide detector combo in the dining room. LPA Clayton observed licensees log fire/disaster drills.

LPA Clayton reminded Licensees that any poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children are to be made inaccessible to children in care.

LPA Clayton reviewed 5 children’s files which contain current contact information for authorized representatives and/or relatives who can assume responsibility for the child, and a signed Consent for Emergency Medical Treatment. LPA Clayton provided licensee with a current Parent’s Rights and Personal Rights Forms.

Licensee provided proof of current CPR/First certification, which expires April 2025. LPA Clayton reminded Licensee that Mandated Reporter certificates are to be renewed every 2 years. Licensee has immunizations records that are in compliance with immunizations required for childcare providers.

LPA Clayton provided applicant with a copy of the safe sleep regulation, Individual Infant Sleep Plan, and a Sleep Log sample. LPA Clayton advised applicant if needed, to access the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and­resources/safesleep as an additional resource.

LPA Clayton informed applicant of the importance of checking for recalled infant devices on the United States Consumer Products 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 the purchased equipment. LPA Clayton discussed of the importance of checking for recalled infant devices on the United States Consumer Products 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 the purchased equipment.


Incidental Medical Services (IMS) are not currently being provided. LPA Clayton provided Licensee with the IMS Sample form and instructed her to submit a copy to the department immediately upon completion. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MIRZA FAMILY CHILD CARE
FACILITY NUMBER: 197411218
VISIT DATE: 03/19/2025
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LPA reminded Licensee of the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

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

Licensee 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 Childcare Home. A Type A Violation and 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.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the home and LPA completed the RSO profile in FAS.



LPA Clayton instructed Licensee to update and submit proof of the following to the Department no later than Monday March 24, 2025:
· completed Mandated Reporter training certificate for herself and her husband
· an updated Disaster Plan
· an updated Parent Board (with current documents, visible to the public)
· proof of 2A:10:BC fire extinguisher

Per Title 22 Regulations and Health and Safety Codes, no Deficiencies cited, Technical Violations were issued today (see LIC 9102).
An exit interview was conducted, a copy of this report was read and provided to licensee Mumtaz.

The inspection report will be made available to the public upon request. LPA Clayton posted a Notice of Site Visit which is required to be posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC809 (FAS) - (06/04)
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