<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495173
Report Date: 09/28/2022
Date Signed: 09/28/2022 01:12:45 PM

Document Has Been Signed on 09/28/2022 01:12 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:VAHID FAMILY CHILD CAREFACILITY NUMBER:
197495173
ADMINISTRATOR:ALI VAHIDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 818-4343
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/28/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:ALI VAHID, APPLICANT TIME COMPLETED:
01:30 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 09/28/2022 at 10am Licensing Program Analyst (LPA) Lisa Clayton met with applicant Ali Vahid for an ANNOUNCED PRE-LICENSING INSPECTION. There were no children in care. The home was toured with the applicant for a health and safety inspection. Hours of operation are Monday through Sunday, 24 hours. Applicant will provide breakfast, lunch, dinner and am/pm snacks.

This is a single-family home which consists of the following: 4 bedrooms, 2 bathrooms, living room/dining room, kitchen, attached garage and fenced backyard. The home is neat and clean with heating and ventilation for safety and comfort. Applicant requested the OFF-LIMIT AREAS are as follows: attached garage, and the west side of the fenced backyard all of which will be inaccessible by child safety gates, closed and/or locked doors and visual supervision.


The Applicant requested the following rooms be ON LIMITS: living/dining room (eating/play area) bedrooms 1, 2, 3, and 4 for napping and learning, bathrooms 1 and 2, and the remainder of the fenced backyard. The ISOLATION AREA will be in bedroom #2. Per applicant, children will nap on cots in the bedroom #3. There are toys and learning materials present at the facility during today's inspection.
.

There are no pools, ponds, or any other bodies of water on the property. Per applicant, there are no firearms in the home. A copy of the mortgage was reviewed and shows control of property.

Any poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children are inaccessible.



The home a fully charged 2A:10:BC Fire Extinguisher, a fully stocked First Aid Kit, 6 working smoke detectors, 2 working carbon monoxide detectors and working telephone. The applicant completed the Health and Safety training on September 7, 2022. Both the applicant and his fingerprint cleared assistant submitted CPR/First Aid certificates that are current and expire March 2024 and September 2024. They also completed the Mandated Reporter Training requirement in September of 2022. The applicant and his assistant are in compliance with the immunization law which pertains to day care providers.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
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: VAHID FAMILY CHILD CARE
FACILITY NUMBER: 197495173
VISIT DATE: 09/28/2022
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 discussed the safe sleep regulations with applicant 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.

The following Safe Sleep Practices were discussed with the applicants; When putting infants down to nap or long periods of sleep, children must be placed on their backs, in a crib, on a firm mattress with nothing in the crib except for a fitted sheet over the mattress. The child must be physically monitored and documented every 15 minutes, check their temperature, color of skin, and breath.


LPA also informed applicant 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.

California Law requires Family Child Care Home applicants to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented. Please report Telephone number changes and/or if you move from home.

The Applicants were informed of the Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the applicants and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541


Email: childcareadvocatesprogram@dss.ca.gov

Update on Incidental Medical Services (IMS):
Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department.
IMS Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag. Incidental Medical Services (IMS) policy was discussed. For further IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm


Currently, the facility does not plan to provide Incidental Medical Services - IMS.

LPA discussed with applicants the process of childcare during a pandemic: facial coverings in day care, social distancing, hand washing hygiene, postings, and cleaning and disinfecting of surfaces and high traffic areas. Children should follow social distancing when indoors. LPA Clayton discussed isolation area with applicant when children are sick. LPA discussed the importance and process of health screenings for children upon arrival to the facility. LPA also provided resources and materials as well as links for COVID-19 to assist the provider. LPA also discussed the proper way to clean and disinfect items used daily throughout the day care, by submerging toys in or spraying with disinfectant and allowing enough contact time prior to wiping down.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC809 (FAS) - (06/04)
Page: 3 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: VAHID FAMILY CHILD CARE
FACILITY NUMBER: 197495173
VISIT DATE: 09/28/2022
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 Clayton reviewed the following:

CHILDREN'S RECORDS REQUIREMENTS:

· LIC 700 Identification and Emergency Information


· LIC 627 Consent for Emergency Medical Treatment
· LIC 282 Affidavit Regarding Liability Insurance
· LIC 9150 Parent Notification Additional Children in Care
· LIC 9927 Individual Infant Sleeping Plan
· LIC 995A Notification of Parent’s Rights
· LIC 613A Personal Rights
· Immunization Record

FACILITY RECORDS:
· LIC 624B Unusual Incident/Injury Report
· LIC 9040 Child Care Facility Roster
· LIC 9052 Employee Rights,
· LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
· LIC 9149 Property Owner/Landlord Consent Form
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates
· Copy of your deed or lease/rental agreement
· Documentation of Fire and Disaster drills
· Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandatedreporterca.com – must be renewed every two (2) years

FORMS TO BE POSTED


· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster

In addition, LPA Clayton informed applicant of the following:

o There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
o Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
o Saucer chairs, bouncers, walkers, or any similar items are prohibited.
o All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
o LPA provided and advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

A complete packet that includes the documents listed above, as well as a ratio flyer, Effects of Lead exposure, PIN 19-02 on Safe Sleep, PIN 19-18 Emergency Disaster, Never Shake a Baby flyer, were discussed with the applicant during this inspection.

The applicants are reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Applicant was reminded of Departments inspection authority, with or without any notice.


This home is recommended for licensing on 09/28/2022. This report shall remain on file for 3 years.
An exit interview was conducted, and a copy of this report was provided to Licensee Ali Vahid.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3