197416547-3-10-2023-58-CC-DLOE-CPSRU5-20230310121922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416547
Report Date: 03/10/2023
Date Signed: 03/10/2023 12:19:31 PM

Document Has Been Signed on 03/10/2023 12:19 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	KAMAN FAMILY CHILD CARE		FACILITY NUMBER:	197416547
ADMINISTRATOR:	KAMAN, MARIAM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 206-5303
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 9	CENSUS: 6	DATE:	03/10/2023
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	10:07 AM
MET WITH:	Mariam Kaman		TIME COMPLETED:	11:30 AM

NARRATIVE

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On 03/10/2023 at 9:55 am Licensing Program Analyst (LPA) Deborah Lowe conducted an unannounced visit, LPA Lowe met with Licensee Mariam Kaman.

LPA Lowe observed 6 children under care and supervision of Licensee and assistant (S1).

Upon entering the child care room LPA Lowe observed 5 play yards. No children were observed sleeping in the play yards. LPA Lowe observed blankets and toys in the play yards.

LPA Lowe advised licensee Per CC Regulation 102425(b) Infant Safe Sleep (b) Cribs or play yards shall be free from all loose articles and objects. Facility will receive a type A citation for this deficiency.

Facility was cited on 06/07/2022 for violation of Regulation 102425(b) Infant Safe Sleep (b) Cribs or play yards shall be free from all loose articles and objects.

LPA Lowe advised per H&S Code 1569.49(2)(A) Civil penalties; regulations setting forth appeal procedures for deficiencies (2) (A) If the department issues a notification of deficiency to a facility for a repeat violation of a violation specified in paragraph (1), the department shall assess an immediate civil penalty of two hundred fifty dollars ($250) per repeat violation and one hundred dollars ($100) for each day the repeat violation continues after citation. The notification of deficiency shall state the manner in which the deficiency constitutes a repeat violation and shall be submitted to a supervisor for review and approval.
LPA Lowe advised facility will receive a civil penalty for the repeat violation.

LPA Lowe discussed with licensee how important safe sleep is in caring for children under 24 months. LPA advised the risks of injury and possible death.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KAMAN FAMILY CHILD CARE	FACILITY NUMBER: 197416547
	VISIT DATE: 03/10/2023

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LPA Lowe reviewed PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect with licensee. LPA printed and provided a copy of PIN-20-24-CCP to licensee during visit.

LPA informed licensee Mariam Kaman that this report dated 03/10/2023 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deborah Lowe informed the licensee to provide a copy of this licensing report dated (insert visit date) that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Licensee was provided a copy of appeal rights.

Exit interview conducted report was reviewed with the licensee

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/10/2023 12:19 PM - It Cannot Be Edited

Created By: Deborah Lowe On 03/10/2023 at 10:28 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KAMAN FAMILY CHILD CARE	FACILITY NUMBER: 197416547
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/10/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/10/2023 Section Cited CCR 102425(b)	1 2 3 4 5 6 7	102425(b) Infant Safe Sleep (b) Cribs or play yards shall be free from all loose articles and objects. This is a repeat violation. This Requirement is not met as evidenced by:	1 2 3 4 5 6 7	During visit LPA observed S1 remove all blankets and toys from play yards. Per Licensee they will watch the safe sleep video on cribsforkids.org/safe-sleep-ambassador and email LPA Lowe a 1 page reveiw of what was learned on or before the end of business on 03/13/2023. LPA email is deborah.lowe@dss.ca.gov
	8 9 10 11 12 13 14	Based on LPA observation. interveiw with licensee, and record reivew, 3 play yards were observed with folded blankets and toys inside play yards, licensee did not comply with the section cited above which poses a potenitial health, safety or personal rights risk to persons 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:

Lisa Rios

LICENSING EVALUATOR NAME:

Deborah Lowe

LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC809 (FAS) - (06/04)

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