197495066-8-23-2023-30-CC-LPHS-CUYUVG-20230823155507

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495066
Report Date: 08/23/2023
Date Signed: 08/23/2023 03:58:09 PM

Document Has Been Signed on 08/23/2023 03:58 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:	EBRAHIM FAMILY CHILD CARE		FACILITY NUMBER:	197495066
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 3	DATE:	08/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Marsel Ebrahim, Licensee		TIME COMPLETED:	04:15 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 8/23/2023, Licensing Program Analyst (LPA) Loyce Phillips conducted a visit for an annual required inspection as well as an inspection for capacity increase for a large family childcare license. LPA met with Licensee Marsel Ebrahim. Licensees guided LPA on a tour of the facility and intends to operate Monday through Friday from 6:00am to 6:00pm. LPA observed 3 children in care. Licensee will provide breakfast, am/pm snack and lunch to children in care.

Licensee does not currently have child-care insurance. Licensee resides in the home with spouse and 2 minor children. All adults have criminal record clearance on file. The areas identified on the facility sketch were inspected. This is a 4 bedroom, 3 bathroom home with living room, dining room, kitchen, attached garage and laundry room located outside the home. The Fire Clearance has been approved with special conditions that the garage cannot be used for day care activities per fire inspector. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition stored on the premises.

The areas that are accessible to children: Living room, bedroom #2 (napping room), bathroom #3 located near the front entry, kitchen and backyard for outdoor play activities. LPA observed age appropriate toys, learning materials and equipment indoors and outdoors.

The areas that are off limits to children: Bedrooms #1, #3, and #4, bathroom #1 and #2 and garage. Storage unit located in the backyard and the garage will be used for storage only.

No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible to children. LPA observed cots for napping. LPA observed a first aid and emergency kit. There is a full charged fire extinguisher located in the kitchen. The facility has a working smoke detectors and carbon monoxide detector, inside the home. The facility has adequate heating and ventilation for safety and comfort. The home has working telephone service and LPA confirmed the phone number is 310-706-1818.

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. Capacity as specified on the license is being maintained.

809-C.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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 4

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: EBRAHIM FAMILY CHILD CARE	FACILITY NUMBER: 197495066
	VISIT DATE: 08/23/2023

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

LPA reviewed LIC 311D with Licensee, forms and records to keep in the family child care home, child's forms and records and records, facility forms and records and required forms to be posted.

LPA reviewed a sample of children's files and observed files were complete with emergency information as required. Licensee mandated reporter training was completed on 2/24/2022. Licensee pediatric CPR/First Aid expires on 2/9/2024. A review of records indicates that all employees have immunization records on file for influenza, pertussis and measles.

This facility does not provide Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Licensee was 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.

Safe Sleep - LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [or facility representative] 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.

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.

809-C

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: EBRAHIM FAMILY CHILD CARE	FACILITY NUMBER: 197495066
	VISIT DATE: 08/23/2023

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

MyChildCarePlan.org – Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, deficiencies are cited and technical advisories were discussed.

Licensee is approve for a capacity increase pending plan of correction and manger's approval.

An exit interview was conducted, a copy of this report was read and provided to the Licensee. This report shall me made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 08/23/2023 03:58 PM - It Cannot Be Edited

Created By: Loyce Phillips On 08/23/2023 at 03:19 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: EBRAHIM FAMILY CHILD CARE	FACILITY NUMBER: 197495066
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and licensee statement, the licensee did not comply with the section cited above in Fire/Emergency drills were not completed which posesa poten tial health, safety or personal rights risk to persons in care.
	POC Due Date: 09/01/2023
	Plan of Correction
1 2 3 4	Licensee will complete Fire/Emergency drills by POC date and at least every six months after date. Licensee will email LPA a copy of completed dril by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Karren Starks

LICENSING EVALUATOR NAME:

Loyce Phillips

LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4