197495042-2-22-2023-58-CC-DLOE-CPB2Y6-20230222164813

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495042
Report Date: 02/22/2023
Date Signed: 02/22/2023 04:48:20 PM

Document Has Been Signed on 02/22/2023 04:48 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: 20	CENSUS: 8	DATE:	02/22/2023
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	01:17 PM
MET WITH:	BIta Nik		TIME COMPLETED:	03:45 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On 02/22/2023 Licensing Program Analyst (LPA) Deborah Lowe conducted an unannounced visit, LPA Lowe met with facility representative, Assistant (A2).

At 1:28 pm LPA observed 8 children in care supervised by assistant (A2), no other adults were present. LPA verified A2 had a cleared background clearance.

LPA reviewed Child Care Facility Roster and found within the 8 children present, 4 were infants under the age of 2, 3 children present were children age 5 years and younger, 1 child was school age. LPA Lowe interviewed child (C2) who stated their age and the elementary school they attend.

LPA advised, Per CC Regulation 102416.5(e) Staffing Ratio and Capacity, (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

LPA advised, Per CC Regulation 102416.5(b) Staffing Ratio and Capacity, (b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (1) Four infants; or (2) Six children, no more than three of whom may be infants; or (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met.

Facility is found to be out of ratio as there was one adult present providing care and supervision to children. Facility will receive a Type A citation for this.

LPA Lowe spoke with A2 who stated the licensee left for a doctor’s appointment at 1:00 pm.

At 2:12 pm LPA Lowe observed one child under the age of 2 was picked up by parent.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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 3

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: 02/22/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

At 2:25 pm Licensee Bita Nik arrived back at facility. At 2:25 pm LPA Lowe observed facility to be in ratio with licensee and A2 both now present.

LPA Lowe spoke with Licensee, Bita who stated they had an emergency and needed to take a relative to the doctor. Bita stated a parent was scheduled to pick up their child by 1:00 pm and Bita thought the assistant would have been okay.

LPA Lowe and Licensee reviewed capacity regulations for a large family child care and for a small family child care. LPA advised when only one adult is present with the children the capacity regulations for a small family child shall be followed. LPA Lowe advised, Licensee needs to have a plan to maintain capacity and ratios when an emergency occurs.

After LPA and Licensee reviewed capacity regulations, Licensee provided LPA Lowe with a declaration of understanding of capacity and ratio regulations and included reason Licensee left A2 alone at facility.

LPA Deborah Lowe informed licensee Bita Nik that this report dated 02/22/2023 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deborah Lowe informed the licensee to provide a copy of this licensing report dated 02/22/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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.

LPA reviewed and provided licenses with appeal rights.

Exit interview conducted and report was reviewed with the licensee Bita Nik.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 02/22/2023 04:48 PM - It Cannot Be Edited

Created By: Deborah Lowe On 02/22/2023 at 04:12 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: 02/22/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/22/2023 Section Cited CCR 102416.5(e)	1 2 3 4 5 6 7	102416.5(e) Staffing Ratio and Capacity, (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This Requirement is not met as evidenced by:	1 2 3 4 5 6 7	LPA Observed one child went home at 2:12 pm and Licensee arrived at facility at 2:25 pm placing facility in ratio. Licensee provided LPA with a declaration of understanding of Ratio and Capacity Regulations dudring visit.
	8 9 10 11 12 13 14	Based on LPA observations, interviews with LIcensee, A2, C2, and record reivew, out of 8 children present, 4 were infants under the age of 2, 3 children present were children age 5 years and younger, 1 child was school age. Faciilty was out of ratio which poses an immediate 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: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3