197495042-1-30-2023-58-CC-DLOE-CNL3M4-20230130172142

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495042
Report Date: 01/30/2023
Date Signed: 01/30/2023 05:21:50 PM

Document Has Been Signed on 01/30/2023 05:21 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:	NIK FAMILY CHILD CARE		FACILITY NUMBER:	197495042
ADMINISTRATOR:	BITA NIK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 926-2140
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 17	CENSUS: 6	DATE:	01/30/2023
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Bita Nik		TIME COMPLETED:	03:30 PM

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On 01/30/2023 at 2:15 pm Licensing Program Analyst (LPA) Deborah Lowe conducted an unannounced visit, LPA Lowe met with Licensee, Bita Nik.

LPA Lowe toured the on and off-limit rooms at the facility. LPA observed 6 children in care supervised by Licensee and one assistant (A1). LPA verified all adults in the home had a cleared background clearance.

Upon entry at 2:15 pm LPA Lowe observed an infant in a pack-n-play in the day care room. LPA Lowe observed the infant to be awake with a blanket and a large stuffed toy in the pack-n-play.

At 2:17 pm in a separate room located in the day care room LPA Lowe observed two additional infants in pack-n-plays. One infant was sleeping, and second infant was awake. Both infants were observed with a blankets in the pack-n-play.

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.

Licensee immediately removed all loose items blanket and stuffed toy from the pack-n-plays. Children who were awake were removed from pack-n-plays.

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-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for 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.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

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: NIK FAMILY CHILD CARE	FACILITY NUMBER: 197495042
	VISIT DATE: 01/30/2023

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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 Lowe reviewed LIC 9227 Individual Infant Sleeping Plan with licensee. LPA printed and provided a copy of LIC 9227 to licensee during visit.

LPA Lowe advised Infant sleep Checks are Required EVERY 15 minutes during sleeping periods Physically check the following for normalcy: Breathing/Overheating/Body Temp./Skin Color/Restlessness/Sleeping Position. LPA reviewed and example of an Infant sleep log. LPA printed and provided a blank copy of an infant sleep log to licensee during visit. LPA Lowe advised the infant sleep log is not a regulatory form, it is an example.

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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D)

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 Bita Nik.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/30/2023 05:21 PM - It Cannot Be Edited

Created By: Deborah Lowe On 01/30/2023 at 04:41 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: NIK FAMILY CHILD CARE	FACILITY NUMBER: 197495042
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/30/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/01/2023 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 Requirement is not met as evidenced by:	1 2 3 4 5 6 7	LPA observed Licensee remove all loose objects from inside pack-n-plays during visit. Licensee stated they will review all provided safe sleep information and will provide a declaration of understanding to LPA Lowe on or before the close of business on 2/01/2023.
	8 9 10 11 12 13 14	Based on LPAs observations, interview with LIcensee, 3 infants were observed in 3 separate pack-n-plays with blankets and one child also had a stuffed toy which poses a potential health, safety or personal rights risk to person 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: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

LIC809 (FAS) - (06/04)

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