198018144-3-30-2023-54-CC-WBIS-CQEP7V-20230330110434

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018144
Report Date: 03/30/2023
Date Signed: 03/30/2023 11:04:56 AM

Document Has Been Signed on 03/30/2023 11:04 AM - 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 CARE		FACILITY NUMBER:	198018144
ADMINISTRATOR:	MAGHOUL, SHOHREH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 965-7992
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	03/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Shohreh Maghoul		TIME COMPLETED:	11:20 AM

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	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 assistants caring for seven children (five preschool and two infants). There are 13 children enrolled attending the facility on a part-time and full-time basis. The facility is in the rear unit (same address) of a two bedroom and one bathroom home. Care is provided in a the rear unit and part of the backyard only. The children have no access to the main house and all other areas are off limits. 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 observed a jacuzzi with a locked cover in an off-limits area of the backyard. LPA informed Licensee Maghoul to keep the jacuzzi cover locked at all times during hours of operation (children do not use the jacuzzi). Areas off-limits to children include: The entire two bedroom, one bathroom front house and the garage. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed toys and play equipment appeared to be safe indoors and outdoors. There is a working telephone maintained in the home. Licensee has no pets. LPA advised Licensee to provide extra care and supervision if she ever decides to get a pet (as animals may be unpredictable). All detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in all areas used by children placed on a high shelf or in a locked cabinet. LPA reminded Licensee that all medicines, chemicals, cleaners, nail polish, shampoos, sharp objects, grills, propane, and similar items must be inaccessible at all times. Per Licensee there are no firearms, weapons and LPA did not observe any. The Emergency Disaster Plan, Parents Rights, Earthquake drill and License was posted in a prominent area. The Licensee's 2A10BC fire extinguisher is due for service in July 28, 2023.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MAGHOUL FAMILY CHILD CARE	FACILITY NUMBER: 198018144
	VISIT DATE: 03/30/2023

NARRATIVE

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Smoke and carbon monoxide detectors in the bedroom were tested and are in operable condition. LPA observed the Licensee and staff have current Mandated Reporter training which expires in 2024. LPA observed the Licensee/Staff documentation indicating immunization regarding MMR, DTAP and TB.

LPA reviewed five children's files which are stored electronically. Files included documentation such as: Parent's Rights, Personal Rights, Affidavit for Liability insurance, Identification and Emergency, Consent for Emergency Treatment, Additional Children in Care, and Immunization records. LPA observed the facility does not document 15 minute checks for infants (children under 2). LPA also went over LIC 9227 safe Sleep documents but did not review any files for children under one years old.

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, 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. Licensee's CPR expires January 2025.

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 and the ADA, available at: http://www.ada.gov/childqanda.htm

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. The LIC 9227 Individual Infant Sleeping The plan shall be completed for each infant up to 12 months of age. LPA discussed the form and explained that the LIC 9227 form that is available on CCLD website.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MAGHOUL FAMILY CHILD CARE	FACILITY NUMBER: 198018144
	VISIT DATE: 03/30/2023

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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 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. Licensee has the required current Mandated Reporter training.

LPA informed Licensee information regarding with Safe Sleep PIN 20-24-CCP. LPA also discussed Entrance Checklist form, Capacity and Ratio, and Items not Permitted. LPA explained these regulations and advised Licensee to ensure that she provides care and supervision adhering to the information provided.

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: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/30/2023 11:04 AM - It Cannot Be Edited

Created By: Warren Birks On 03/30/2023 at 10:41 AM

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: 03/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(c)(2)

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. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above: Licensee indicated that she has infants and has not implemented the Safe Sleep form yet which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/14/2023
	Plan of Correction
1 2 3 4	Licensee will provide ecidence of completed LIC 9227 form for infants.

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above: Licensee indicated she checks on infants constantly but did not document 15 minute checks which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/04/2023
	Plan of Correction
1 2 3 4	Licensee will provide proof of 15 minute checks.

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: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

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