304202176-12-9-2024-06-CC-SJJG-DBT2BS-20241209161536

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304202176
Report Date: 12/09/2024
Date Signed: 12/09/2024 04:15:51 PM

Document Has Been Signed on 12/09/2024 04:15 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	RAHMAN, RIZWANA		FACILITY NUMBER:	304202176
ADMINISTRATOR/ DIRECTOR:	RAHMAN, RIZWANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 651-8175
CITY:	IRVINE	STATE: CA	ZIP CODE:	92604
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 6	CENSUS: 4	DATE:	12/09/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:45 PM
MET WITH:	Licensee Rizwana Rahman		TIME VISIT/ INSPECTION COMPLETED:	04:30 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 12/9/2024, Licensing Program Analyst (LPA), Christine Jung, conducted an onsite inspection for the purpose of an Annual Inspection. At 1:45PM, LPA was met at the door by Assistant 1 (A1), Shakeel Rahman. A1 stated that licensee, Rizwana Rahman, was not present because they were picking up children. A1 denied entry to LPA and stated that the licensee would return in 15 to 20 minutes. LPA requested to speak with the licensee over the phone, but A1 denied the request. Although LPA reminded them of the Department’s inspection authority, A1 still denied entry. LPA proceeded to contact the local police department, but while speaking with the police department, A1 allowed the LPA to enter. Licensee arrived about 15 minutes after LPA entered the facility. The overall census observed was two (2) infant children being supervised by A1. Licensee arrived with two additional children who were school aged at approximately 2:00PM. During the inspection, it was determined the facility is operating within its licensed capacity as specified on the license. Facility hours are 7:00AM to 6:00PM, Monday through Friday. The Facility Personnel Report Summary reviewed on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. (Go to Page 2)

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024

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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Document Has Been Signed on 12/09/2024 04:15 PM - It Cannot Be Edited

Created By: Soo Jin Jung On 12/09/2024 at 03:47 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAHMAN, RIZWANA	FACILITY NUMBER: 304202176
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/09/2024

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 interview and record review, the licensee did not comply with the section cited above in that, licensee did not conduct an emergency drill at least once every six months, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2024
	Plan of Correction
1 2 3 4	Licensee stated they will conduct an emergency drill and send a copy of the emergency drill log to LPA via email by due date.

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in that, licensee did not maintain a 15 minute Sleep Log for infants under 24 months, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2024
	Plan of Correction
1 2 3 4	Licensee stated they will maintain Sleep Logs for infants under 24 months going forward. Licensee stated they will submit copy of Sleep Logs for Child 3 (C3) and Child 4 (C4) for 12/10-12/24 and submit copies of the logs to LPA via email by 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:

Martha Malane

LICENSING EVALUATOR NAME:

Soo Jin Jung

LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAHMAN, RIZWANA	FACILITY NUMBER: 304202176
	VISIT DATE: 12/09/2024

NARRATIVE

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(Page 2)
During today’s inspection, A1 led LPA on a tour of the inside areas identified in the facility sketch as accessible to day care children. Off limits areas are made inaccessible by means of locked doors and child gate. The daycare area consisted of a living room, restroom, and kitchen. There were working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory requirements. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. There were no poisons or other items observed which could pose a danger to children. If they were observed, they were locked or inaccessible. Licensee stated there are no firearms and/or other dangerous weapons in the facility and none were observed during today's inspection. The home had age-appropriate toys for the ages served. LPA verified there is a working telephone service (cellular service), licensee was reminded that childcare phone must remain in the childcare at all times. Licensee stated that they do not take the children outside for outdoor play. Licensee stated that there are no bodies of water on the premises. Licensee had a walker without wheels in the premises. Licensee stated that it was only being used to block the area under the stairs so that the infants would not crawl into the space. Upon LPA’s request, licensee removed the walker into an off-limit area and stated they will not be using it in the facility going forward.

Licensee and assistant’s files were reviewed during the facility inspection on this date. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family childcare home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against influenza, pertussis, and measles for licensee and assistant were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training and to renew the training every two years. Licensee and assistant stated that they have not taken the mandated reporter training due to the training not being available in Hindi. Licensee and assistant possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires August 2026. Licensee stated that their last emergency drill was conducted in October 2023. The licensee did not conduct an emergency drill within the past six months as required by Title 22 regulations; see LIC 809D for deficiency.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAHMAN, RIZWANA	FACILITY NUMBER: 304202176
	VISIT DATE: 12/09/2024

NARRATIVE

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(Page 3)
Children's records were reviewed, and there was a separate file for four (4) children. LPA observed two (2) infants from 0-24 months. LPA did not observe a Sleep Log for infants from 0-24 months in children’s files. Licensee stated that they have not kept current Sleep Log for the two infants enrolled; see LIC 809D for deficiency. Licensee has maintained a roster for children enrolled. However, licensee did not maintain, in each child’s record, a copy of the emergency information card as required in Section 102417(g)(7); see LIC 9102 for Technical Violatoin.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

The licensee understands they must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care for and supervise children while absent. The substitute adult must have the required criminal record clearance, child abuse index clearance, immunizations, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

CCLD website www.cdss.ca.gov/inforesources/community-care-licensing was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee.

(Go to Page 4)

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAHMAN, RIZWANA	FACILITY NUMBER: 304202176
	VISIT DATE: 12/09/2024

NARRATIVE

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(Page 4)
LPA discussed the safe sleep regulations with licensee 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. LPA also informed licensee 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.

Based on LPAs observations, record reviews, and interviews, the following violations were observed and are being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1; see LIC 809D for violations cited: 2 Type B.

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.

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.

During the exit interview, the licensee, Rizwana Rahman, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Rizwana Rahman.

End of Report.

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024

LIC809 (FAS) - (06/04)

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