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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417320
Report Date: 03/10/2025
Date Signed: 03/10/2025 10:47:00 AM

Document Has Been Signed on 03/10/2025 10:47 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:AL-DHAIF FAMILY CHILD CAREFACILITY NUMBER:
197417320
ADMINISTRATOR/
DIRECTOR:		AL DHAIF, IBTISAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 235-9139
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
03/10/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Ibtisam Al Dhaif, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Tatiana Bickham conducted an unannounced annual inspection to the above facility on 3/10/2025.  LPA arrived at the facility at 900 AM, identified self and met with Noor Al Dhaif who guided LPA on a tour of the facility. At 9:34 AM Ibtisam Al Dhaif, other Licensee arrived. There were 3 day care children present during today’s inspection. At 9:46 Licensee Noor Al-Dhaif left the facility.

During the annual visit conducted on 1/29/25, the following deficiencies were issued:

Type B- 102417(b)- The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. LPA gave Licensee a POC due date of 2/19/25, LPA did not receive proof of corrections. LPA extended the date until 3/7/25. LPA arrived at the home and found the home not to be organized or orderly.

Type B- 102425(j)(1)- The provider shall physically check on the infant every 15 minutes and complete safe sleep log. LPA did not receive the 15-minute log by the due date of 2/19/25. Per Licensee, their is only 1 infant enrolled and they check on the infant but does not complete the log.

Type B- 1596.8662(b)(1)- Both Licensee's shall complete the Mandated Reporter Training. LPA received proof of Mandated Reporter Training for Ibtisam by the due date but did not receive the completed Mandated Reporter Training for the other Licensee, Noor.

Type B- 1597.622(a)(1) A person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. LPA gave Licensee's until the end of March to provide proof of the required immunization's.

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SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Tatiana Bickham
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: AL-DHAIF FAMILY CHILD CARE
FACILITY NUMBER: 197417320
VISIT DATE: 03/10/2025
NARRATIVE
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The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22. The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Ibtisam Al-Dhaif, Licensee, a copy of the report and appeal rights were provided.

Page 2.
SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Tatiana Bickham
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/10/2025 10:47 AM - It Cannot Be Edited


Created By: Tatiana Bickham On 03/10/2025 at 10:05 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: AL-DHAIF FAMILY CHILD CARE
FACILITY NUMBER: 197417320

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/28/2025
Section Cited
HSC
1596.8662(b)(1)

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(1) ... A licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...

This requirement is not met as evidenced by:
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Licensee shall completed the Mandated Reporter Training by the date listed.
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Based on LPA observation and Licensee stating Noor did not complete the Mandated Reporter Training.
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Type B
04/04/2025
Section Cited
HSC102417(b)

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(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
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Licensee shall organize the day-care room and living and dining room. If areas are off limits, the Licensee shall make them inaccessible to children in care.
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Based on LPA observations Licensee did not comply with having the home clean and orderly during business hours.
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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:Raul Navarro
LICENSING EVALUATOR NAME:Tatiana Bickham
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/10/2025 10:47 AM - It Cannot Be Edited


Created By: Tatiana Bickham On 03/10/2025 at 10:09 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: AL-DHAIF FAMILY CHILD CARE
FACILITY NUMBER: 197417320

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/28/2025
Section Cited
CCR
102425(j)(1)(2)

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(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: (1) The provider shall physically check on the infant every 15 minutes. (2) The provider shall check and document the following:(A)Lbored breathing. (B)Signs of distress...(C)Infants up to 12 month of age who are
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Licensee's shall document when they check on each infant. LPA provided Licensee with a copy of the infant safe sleep form.
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sleeping in a position other than on their back.
This requirement has not been met as evidenced by:
Licensee stating they are not documentating when they check on the infants.

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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:Raul Navarro
LICENSING EVALUATOR NAME:Tatiana Bickham
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2025


LIC809 (FAS) - (06/04)
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