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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494350
Report Date: 08/10/2023
Date Signed: 08/10/2023 04:19:53 PM

Document Has Been Signed on 08/10/2023 04:19 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:BEGUM FAMILY CHILD CAREFACILITY NUMBER:
197494350
ADMINISTRATOR:BEGUM, IMTIAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 747-0787
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
08/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:39 PM
MET WITH:Imtiaz BegumTIME COMPLETED:
04:30 PM
NARRATIVE
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On 8/10/23 at 11:00 am Licensing Program Analyst (LPA) Maria Rendon arrived to 7541 1/2 N Claybeck Ave, Begum Family Child Care to conduct an unannounced inspection. Upon arrival LPA was greeted by Licnesee Imtiaz Begum who was in the front house 7541 Claybeck Ave Facility #197493669, taking care of her grandchild. Licensee informed that Adult #1 will arrive shortly Adult #1 arrived to the facility at 11:10am and guided LPA on a tour of the facility. Census was taken and LPA observed 13 children, 4 staff, and 1 parent volunteer.

LPA requested a copy of the children's roster and Adult #1 informed LPA that she currently does not have a a children's roster. LPA informed Adult #1 that a roster is needed in order to conduct the inspection. LPA observed Adult #1 cross out Facility Number 197493669 and wrote 197494350 and added children in the roster that were currently in the facility. LPA also informed Adult #1 that names of children that have left the daycare will also need to be added to the roster. LPA received a copy of the most updated children's roster.

A Type B deficiency is being cited today based on LPA observation, interview, and record review in accordance with the California Code Regulations, Title 22, see LIC 809D.

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

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A
copy of this report, notice of site visit, and appeal rights were discussed and left with Licensee Imitiaz Begum, whose signature on this form confirm receipt of these documents.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
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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Document Has Been Signed on 08/10/2023 04:19 PM - It Cannot Be Edited


Created By: Maria Rendon On 08/10/2023 at 03:52 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: BEGUM FAMILY CHILD CARE
FACILITY NUMBER: 197494350

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/10/2023
Section Cited
CCR
102417(8)

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102417 Operation of A Family Child Care Home (B) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidence by:
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Licensee was able to provide LPA an updated and most recent children's roster by the end of the visit.
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Based on observation, interview, record review the licensee did not have an updated children's roster upon request from LPA, which poses potential Health and Safety, or Personal Rights to persons in care.
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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:Lisa Rios
LICENSING EVALUATOR NAME:Maria Rendon
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023


LIC809 (FAS) - (06/04)
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