197495134-11-2-2022-58-CC-LSTN-CKSVL4-20221102163117

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495134
Report Date: 11/01/2022
Date Signed: 11/02/2022 04:32:23 PM

Document Has Been Signed on 11/02/2022 04:32 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:	HARASIS FAMILY CHILD CARE		FACILITY NUMBER:	197495134
ADMINISTRATOR:	RAZIA HARASIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 612-8839
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91304
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	11/01/2022
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Razia Harasis		TIME COMPLETED:	02:34 PM

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THIS OFFICE MEETING WAS CONDUCTED VIRTUALLY VIA MICROSOFT TEAMS DUE TO COVID-19 PRECAUTIOARY MEASURES

On 11/01/2022 at 2:00PM, Licensing Program Manager (LPM) Lisa Rios, Licensing Program Manager (LPM) Rita Ramos and Licensing Program Analyst (LPA) Laticia Thompson conducted an informal meeting with Applicant, Razia Harasis (Noorzay) . The purpose of the meeting was to discuss the Application for a Family Child Care Home License submitted to the department.

During the meeting LPMs discussed Applicant’s previous history as a licensed child care provider. Applicant held a childcare license from 10/12/12 to 02/06/20.

Applicant provided documentation to the department noting that in the time of not having a license, Applicant attended courses and earned educational hours in the areas of child growth and development. In addition, Applicant disclosed that they completed 3 months of community service and will provide a copy of the reference letter they received for the services provided.

In review of the application submitted, the following corrections and documentation are required to continue the application and licensing process.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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: HARASIS FAMILY CHILD CARE	FACILITY NUMBER: 197495134
	VISIT DATE: 11/01/2022

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1. LIC 279: Application for a Family Child Care Home License needs to be revised to reflect the correct address as noted on the lease provided.

2. LIC 610A: Emergency Disaster Plan requires corrections on emergency contact numbers and temporary relocation information.

3. LIC 999: Facility Sketch needs to be revised and indicate room measurements.

4. Copies of individuals residing in the home and of those who will assist in providing care for children need to be submitted.

5. LIC 508: Criminal Record Statement for all individuals residing in the home and of those who will assist in providing care for children need to be submitted.

6. Written, signed and dated declaration from applicant stating the address and name change

7. Copies of reference letters

The following corrections are due no later than 11/15/22.

A copy of this report was emailed and mailed to the Applicant. Applicant was advised to submit a signed copy with original signatures to the department.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

LIC809 (FAS) - (06/04)

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