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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018144
Report Date: 03/01/2022
Date Signed: 03/01/2022 02:11:00 PM

Document Has Been Signed on 03/01/2022 02:11 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MAGHOUL FAMILY CHILD CAREFACILITY NUMBER:
198018144
ADMINISTRATOR:MAGHOUL, SHOHREHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 965-7992
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Shohreh MaghoulTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required 1 Year inspection. LPA met with Licensee Shohreh Maghoul who guided LPA on a tour of the facility. Upon arrival LPA observed the Licensee and cleared assistant caring for six preschool and four infant children. There are children enrolled attending the facility on a part-time and full-time basis.

The Licensee provides all care in a rear unit and in the backyard (same address as main house). The Licensee indicates that the children have no access to the main house. Licensee informed LPA Birks that when initially licensed in 2015, she informed the Department that care would be provided in the rear unit. At 9:30am LPA observed the daycare area to have a small kitchen equipped with a sink, refrigerator, and microwave. The daycare area also has a barricaded wall heater and a bathroom. LPA also observed that children have access to a a barricaded patio space located in the entrance of the rear unit. The Licensee indicated that children only use one side of the backyard however, the whole backyard is accessible as there are no locked or immovable barriers preventing access anywhere.

Areas off-limits to children and parents include: The entire two bedroom one bathroom front house and the garage. Areas accessible to children were inspected to ensure they are clean and orderly with ventilation and heating for the safety of the children. At 9:30 LPA observed lotions and creams in the daycare area near the changing table. LPA deemed the table semi-inaccessible however, informed the Licensee to place the items in an area that is higher than to make more inaccessible.

At 9:40am LPA observed lawn care chemicals and disinfectant in a side yard away from the barricaded area and a parked vehicle in the driveway (near a basketball and tricycle play area). LPA informed Licensee the car must be removed or a gate added and the items although away from the barricaded area, they must be more inaccessible. LPA also informed LPA also observed an inaccessible empty jacuzzi with a locked cover that held the weight of the Licensee.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MAGHOUL FAMILY CHILD CARE
FACILITY NUMBER: 198018144
VISIT DATE: 03/01/2022
NARRATIVE
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Per Licensee there are no firearms or weapons and LPA did not observe any. LPA observed Parents Rights and License to be posted. The children's roster and Disaster drill is current (last date of drill

At approximately 10:00am LPA observed the following: The required 2A 10BC fire extinguisher is within the required annual service date (service due July 12, 2022) and smoke and carbon monoxide detector to be operable. At 11:20 LPA observed Licensee's CPR to be current however, it did not have the EMSA certified label/sticker. LPA informed Licensee that CPR and First Aid must be EMSA certified. LPA observed the Licensee must renew Mandated Reporter training and staff #1 must complete Mandated Reporter training. The Licensee and staff #1 has evidence of immunization against influenza, pertussis, and measles.

At 11:45 LPA reviewed children's files. Child forms #1 through #10 missing admission dates and child files #2, #9 and #10 files are missing the LIC 700 Identification and Emergency forms. LPA advised Licensee to audit files to ensure compliance and communicate with parents to ensure all documents are received. LPA also informed Licensee that hardcopy forms must be readily at all times and kept for a minimum of three years after children are no longer enrolled.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty. LPA advised to ensure all adults that come into the home are fingerprint cleared and associated.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present. CPR and First aid must be EMSA certified.

Incidental Medical Services (IMS) policy was discussed. For 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
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022
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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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MAGHOUL FAMILY CHILD CARE
FACILITY NUMBER: 198018144
VISIT DATE: 03/01/2022
NARRATIVE
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 During this time LPA observed other toys and items that appeared to be safe and age appropriate (inside the home and in the backyard. The backyard area is surrounded by gates higher than five feet.

At 12:50pm LPA informed Licensee of appropriate sleeping arrangements for infants. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and document the child's condition. Licensee is missing LIC 9227 Individual Infant Sleeping forms for all infants. LPA to submit form to Licensee.

Plan shall be completed for each infant up to 12 months of age. LPA explained form is available on CCLD website. The Licensee was advised on the inaccessibility of hazards, Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA informed Licensee regarding PIN 20-24-CCP. LPA observed blankets in cribs which is not permitted per PIN 20-24-CCP.



LPA discussed LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (use LIC624B for written report). Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com.

LPA also discussed Covid Self Assessment and Covid safety according to the Los Angeles County Health Department.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Shoreh Maghoul.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/01/2022 02:11 PM - It Cannot Be Edited


Created By: Warren Birks On 03/01/2022 at 01:24 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MAGHOUL FAMILY CHILD CARE
FACILITY NUMBER: 198018144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation LPA observed a parked vehicle in the driveway that is not in use at this time. The Licensee did not comply with the section cited above as this poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/02/2022
Plan of Correction
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Licensee plans to move the vehicle by the due date.
Type B
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as LPA observed lotions and creams in an area which was semi-inacessible but LPA deemed more accessibility is needed. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/02/2022
Plan of Correction
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Licensee will place items in a higher area by the due date.
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:Karen Chambers
LICENSING EVALUATOR NAME:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 03/01/2022 02:11 PM - It Cannot Be Edited


Created By: Warren Birks On 03/01/2022 at 01:24 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MAGHOUL FAMILY CHILD CARE
FACILITY NUMBER: 198018144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
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:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as LPA observed blankets in the infant cribs which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2022
Plan of Correction
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Licensee indicated she will remove blankets.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above as The Licensee needs to renew Mandated Reporter training and staff #1 needs initial training. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/01/2022
Plan of Correction
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Licensee will submit by the due date.
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:Karen Chambers
LICENSING EVALUATOR NAME:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 03/01/2022 02:11 PM - It Cannot Be Edited


Created By: Warren Birks On 03/01/2022 at 01:24 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MAGHOUL FAMILY CHILD CARE
FACILITY NUMBER: 198018144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as the Licensee's current CPR is not EMSA certified which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/01/2022
Plan of Correction
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Licensee indicated she will submit by the due date.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as Child 2,9 and 10 ID and Emergency is mislocated. All files #1 through #10 missing admission date.which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/01/2022
Plan of Correction
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Licensee indicated she will submit by the due date.
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:Karen Chambers
LICENSING EVALUATOR NAME:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 03/01/2022 02:11 PM - It Cannot Be Edited


Created By: Warren Birks On 03/01/2022 at 01:24 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MAGHOUL FAMILY CHILD CARE
FACILITY NUMBER: 198018144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above as Licensee is not maintaining safe sleep records for infants or a 15 minute log for all infants. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2022
Plan of Correction
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2
3
4
Licensee indicated she will submit by the due date.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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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:Karen Chambers
LICENSING EVALUATOR NAME:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022


LIC809 (FAS) - (06/04)
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