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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417805
Report Date: 04/11/2023
Date Signed: 04/11/2023 04:34:20 PM

Document Has Been Signed on 04/11/2023 04:34 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:HAJIDAMJI FAMILY CHILD CAREFACILITY NUMBER:
197417805
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 11DATE:
04/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee Zehra Hajidamji TIME COMPLETED:
05:00 PM
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On 4/11/2023 Licensing Program Analyst (LPA) Dalicia Adkins conducted an unannounced Annual Required Inspection and was met by Licensee, Zehra Hajidami Also present was/were Staff #1 (S1) and Staff#2 (S2). Days and hours of operation are Monday - Friday 8:00am- 5:00pm.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that bathroom and dinning room are used to provide care. The kitchen is off limits and is made inaccessible by child security gate. All other rooms are off-limits and made inaccessible by use of locked doors.

Capacity as specified on the license is not being maintained. At 11:15am Adkins observed 5 infants in care. LPA counted 5 infants in the dinning room and outside play area. LPA discussed with licensee that the facility capacity is 8, LPA confirmed with licensee that facility is over capacity. Licensee stated that she allowed more children due to the Covid and the need of parents needing child care. Children' record review confirmed infants in care were. This is a violation of California Code of Title 22 Regulation- Staffing Ratio and Capacity, LPA confirmed with licensee that facility exceeded the capacity of 4 infants for a family child care home.

P. 1

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HAJIDAMJI FAMILY CHILD CARE
FACILITY NUMBER: 197417805
VISIT DATE: 04/11/2023
NARRATIVE
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This is a Type A deficiency which poses a immediate health health and safety risk to children in care. A copy of this report shall be provided to parents and any new enrollees for the next 12 months, signed Acknowledgement of Receipt( LIC 9224 ) must be maintained in children's file. Refer to LIC 809 D page.

LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. LPA discussed LIC 9227 and Pin 20-24 safe sleep regulation with licensee.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present.

There is no swimming pool or other bodies of water on the premises There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

P. 2

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023
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: HAJIDAMJI FAMILY CHILD CARE
FACILITY NUMBER: 197417805
VISIT DATE: 04/11/2023
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There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. The home has working telephone service and LPA confirmed the phone number is (310 ) 866-9065.

Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s Mandated Reporter Training expired, LPA Adkins provided technical assistance. Technical Violation given; refer LIC 9102 technical violation- advisory. Licensee’s pediatric CPR/First Aid expires on 03/3023.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Incidental Medical Services (IMS) not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. 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.

LPA and Licensee discussed 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

P.3

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023
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: HAJIDAMJI FAMILY CHILD CARE
FACILITY NUMBER: 197417805
VISIT DATE: 04/11/2023
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies cited: Records - Type B: 1597.622(a)(1) - Child care assistants are missing personnel records; immunization records
Staffing Ratio and Capacity - Type A: 102416.5(a) - Licensee is over capacity, LPA observed 5 infants in care (see next page, 809 D) Licensee was provided a copy of appeal rights.

LPA provided technical assistance; Facility Administration - Technical Violation: 1596.8662(b)(1) - Licensee mandated reporting certification expired. LPA provided technical assistance; licensee registered for mandated reporting training on Community Care Licensing website. Licensee will send a copy of completion to LPA via email by April 17, 2023.
Facility Administration - Technical Violation: 1597.622(c) - Personnel records are not up kept. Licensee will send LPA a copy of completed files for child care attendants. Facility Administration - Technical Violation: 102416.1(d) - Personnel records are not maintained, not all records available for licensing review.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

This report shall be made available to the public upon request. Notice of site visit given and must be posted for 30 days. Exit interview conducted.

P.4

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/11/2023 04:34 PM - It Cannot Be Edited


Created By: Dalicia Adkins On 04/11/2023 at 03:22 PM
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: HAJIDAMJI FAMILY CHILD CARE
FACILITY NUMBER: 197417805

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review , the licensee did not comply with the section cited above in 11 out of 5 children were infants which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/11/2023
Plan of Correction
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License agreed to write a written declaration statement, acknowledging
understanding of facility capacity. Licensee agreed to watch online training/videos on Community Care LIcensing website; 1. How Many Children Can Attend a Family Child care. 2. Supervising Children in Family Child Care. 3. Chidlren Personal Rights in Child Care. Licensee will send LPA a copy via email by April 17, 2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Maureen Neal
LICENSING EVALUATOR NAME:Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 04/11/2023 04:34 PM - It Cannot Be Edited


Created By: Dalicia Adkins On 04/11/2023 at 03:22 PM
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: HAJIDAMJI FAMILY CHILD CARE
FACILITY NUMBER: 197417805

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review the licensee did not comply with the section cited above in 3 out 3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/05/2023
Plan of Correction
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Licensee agreed obtain a copy of immunization records from Staff 1 (S1) and Staff 2 (S2) and update personnel files. Licensee agreed obtain immuization records and send LPA a copy via email by May 5, 2023. Licensee will also send copies of S1 and S2 immunization records by May 5, 2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Maureen Neal
LICENSING EVALUATOR NAME:Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023


LIC809 (FAS) - (06/04)
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