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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494350
Report Date: 07/09/2026
Date Signed: 07/09/2026 12:14:54 PM

Document Has Been Signed on 07/09/2026 12:14 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/
DIRECTOR:		BEGUM, IMTIAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 747-0787
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
07/09/2026
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:55 AM
MET WITH:Imitiaz Begum, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 07/09/2026, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Required 3-Year inspection at 7541½ N. Claybeck Avenue, Burbank, CA. 91505. LPA arrived at the facility at 08:25 AM, identified self and met with Imtiaz Begum, Licensee, who guided analyst on a tour of the inside of the facility. There were 6 children, two (2) assistants, Hajra Abbasi, Licensee Facility Number 197494669 (main house) present upon arrival. LPA provided Licensee with a copy of the LIC126 Entrance Checklist to help facilitate the inspection. Facility operation hours are Monday to Friday from 8:00AM to 05:30PM.

The family child care home is a one-story Accessory Dwelling Unit (ADU) with a combination living/dining/kitchen room, bedroom, and bathroom. There is a front and back yard with a fence that surrounds both facilities.

The facility is located on the same lot as Facility License Number 197494669, which currently has no children enrolled.

The children enter the child care home facility from the front gate and walk through the drive way to the ADU.

During the tour, LPA observed that the combination living/ dining/ kitchen room is used for infant child activities, indoor play, learning lessons, and eating. LPA observed there were safe toys, play equipment, tables, chairs, and other materials that were appropriate for the ages of the children. Licensee stated that the facility provides snacks and breakfast daily and parents provide lunches. Food that is prepared by the parents is labeled with each child’s name. LPA observed that children’s personal items are stored in bins and Page 1 of 4
NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2026
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: BEGUM FAMILY CHILD CARE
FACILITY NUMBER: 197494350
VISIT DATE: 07/09/2026
NARRATIVE
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 labeled with the child’s name. LPA observed that bedroom #1 is used for children 2 years and above child activities, play, learning activities, and sleeping. LPA observed tables, chairs, play materials, play yard, and cots. Licensee stated that they provide bed linens which are laundered each week. Children in care use bathroom #1 located in the living/ dining/ kitchen room, LPA observed a vanity cabinet with household cleaning products that is made inaccessible with a child proof latch, the bathroom is safe and sanitary.

There are no rooms inaccessible to parents and children.

LPA observed that there is no outdoor play area. The facility is currently adding additional rooms to the ADU and has provided the Department with the specifications of the construction. LPA observed that there are barriers set up to block the areas under construction and keep the area in a safe condition, free of sharp, loose, or pointed parts. LPA did not observe construction activity while the children were present.

LPA reminded Licensees that children are to be supervised at all times. LPA advised Licensee that children shall not be left in parked vehicles and car seats are used for transportation purposes only and are not used for sleeping children.

Licensee stated that when a child shows signs of an illness the child will be isolated in the bedroom #1, away from the other children until their parents arrive.

There is a combination smoke and carbon monoxide detector located in the combination living/ dining/ kitchen room, the device was tested and is operable. There is a working 2 10A: BC fire extinguisher, the dial indicates fully charged and was purchased on 07/18/2025. LPA did observe a fireplace or any open-faced heaters. There is adequate heating and ventilation for safety and comfort. An emergency fire/disaster drill has not been completed within the last 6 months and was completed on 06/15/2025. There is telephone service via a cellphone and LPA reminded Licensee that the cellphone must remain in the facility during the hours of operations.

Licensee stated there is a dog on the premises during the hours of operations the dog is kept on the side of the house (Facility Number 197493669) behind a secured gate. Licensee stated there are chickens on the premises, the chickens are kept in a coop near the facility entrances that is made inaccessible with the use of a gate blocking entry to the area.
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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: BEGUM FAMILY CHILD CARE
FACILITY NUMBER: 197494350
VISIT DATE: 07/09/2026
NARRATIVE
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Per Licensee, there are no firearms or ammunition or other weapons on the premises; LPA did not observe any firearms or other weapons on the premises. Per Licensee, there are no poisons on the premises; LPA did not observe any poisons on the premises. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible with the use of latches.

LPA did review samples of children’s records and documented LIC857. LPA reviewed the Licensee and Staff records and documented on LIC859.

Licensee Pediatric CPR/First Aid was expired and Assistant #1 expires on 11/2027 and Assistant #2 expires on 11/2027. Licensee’s Mandated Reported Training Certificate was completed 05/06/2025.

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.

Licensees were reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

There are currently two (2) infants enrolled at the facility. LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for and removing any recalled infant devices on the United States Consumer Product 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 their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22- 02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: BEGUM FAMILY CHILD CARE
FACILITY NUMBER: 197494350
VISIT DATE: 07/09/2026
NARRATIVE
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Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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

Imtiaz Begum, Licensee left the facility at 10:48AM for an appointment. Exit interview conducted and report was reviewed with the Hajra Abbasi.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC809 (FAS) - (06/04)
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