304313131-12-7-2021-06-CC-KDEI-C9GSJE-20211207125502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313131
Report Date: 12/07/2021
Date Signed: 12/07/2021 12:56:21 PM

Document Has Been Signed on 12/07/2021 12:56 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	OMER, MAHAM		FACILITY NUMBER:	304313131
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 13	DATE:	12/07/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Administrator Ms. Omer, Maham		TIME COMPLETED:	01:00 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	Licensing Program Analyst (LPA) Desai, Ketki conducted an unannounced In-person Case Management. Licensee initiated inspection for a change in capacity at the existing Family Child Care home. LPA met with Licensee Ms. Omer, Maham present at home with one assistant, providing care and supervision to 13 preschool age children. Licensee has been a Child Care provider for a Small Family home since 2017, making her qualified to operate a Large Family Child Care home. LPA observed COVID19, precautions at the facility, with required postings, temperature checks upon arrival, social distancing and activities being held in small groups. A review of the Facility Personnel Report Summary indicates all adults, residing in the home who require caregiver background check clearances are cleared. There are two adults residing in the home. Licensee is requesting a Large family childcare home license. Per Licensee, operation hours will be Monday to Friday, 8:00 AM to 5:00 PM care and supervision shall be provided to children ages 2-5 years only. Per Licensee she only enrolls children between 2-5 years of age, therefore are no children going to Kindergarten program. A review of the Facility Personnel Report Summary dated (12/7/21) indicates all adults residents, who require caregiver background check clearances exemptions is received and are cleared. Licensee currently has two assistants coming in every day and they have obtained the required clearances . Licensee stated currently she is not registered with any Foster Care agency or holds a foster parent license, She was informed if any changes are to occur, Department shall be notified. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has a central Air /Heating system, the A/C unit is installed in the corner of the side yard inaccessible to children with a safe barrier surrounding it. (Page-1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OMER, MAHAM	FACILITY NUMBER: 304313131
	VISIT DATE: 12/07/2021

NARRATIVE

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This is a two story town home with three bedrooms/ 2.5 bathrooms/ living area/ kitchen with dining room/ laundry area/ attached garage / back patio area/ back yard and 2 side walkway adjoining the patio. There is an emergency door at the end of one side walkway.Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. Per Licensee there are no poisons on the premises). Licensee was advised that any poisons must be locked with a key or combination lock.
Based on the Facility Sketch submitted, areas off limits to children and parents are: Second level of the home that includes Three Bedrooms, Two bathrooms and kitchen are designated as off limits areas. The off limits areas are made inaccessible by means of door latches. There is a stairway in the home leading to the second level of the home with a child safety gate at the bottom, making the second level of the home inaccessible to children. Kitchen is open, but both the sides are made inaccessible. One side has a baby gate and one side has a small working table making the kitchen area inaccessible to children. Cabinets have child safety latches installed. Sharp objects are placed in the locked drawers. Side walkway on the right hand side is inaccessible, Licensee has placed a wooden box as a barrier. Licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Designated Child care areas: Children shall enter the home through the main door of the home, they enter into the small passage area leading into the living area, which is the main day care room, There is a fire place in the living area with a safe barrier across it. Living area was observed to have age appropriate toys and educational activities. Children's bathroom is located on the left side of the passage area, next to the stairway it was observed to be safe and free of hazardous items. Garage is redesigned with wooden flooring and indoor activities are held here. Per Licensee children do not eat or sleep in the garage.

OUTDOOR PLAY AREA: The children shall use the back patio and yard for outdoor activities, the yard is completed fenced with concrete and artificial grass flooring. Shade is provided by the roof and natural tree shade. There are age appropriate outdoor toys and activities for enrolled children.

Per Licensee there are no, firearms, pets, weapons or bodies of water on the premises.

Licensee serves Lunch to children in care. She does have additional snacks for children. Per Licensee, due to COVID , all the children bring snacks from home and they all leave by 1:00 PM since their parents are working from home. Snack is brought from the home and those containers shall be labeled with child’s name and properly stored or refrigerated. Licensee serves them home cooked meals and is not enrolled in the Food Program. (Page-2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OMER, MAHAM	FACILITY NUMBER: 304313131
	VISIT DATE: 12/07/2021

NARRATIVE

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Children nap on the mats, linens and blankets are provided by the parents, stored in their individual cubbies . Currently children are present only till 1:00 PM, so there is no napping.

Licensee has completed the required Pediatric First Aid and CPR training which expires 10/16/23. There are first aid supplies available.

Licensee has a cell phone which is used for childcare, and remains on the premises during hours of operation.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

The following was discussed with the applicant: ·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.

Civil Penalties will be assessed if not in compliance.

·In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license along with TB test / Immunization and Mandated Reporter training.
·Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
Licensee was also made aware of the Child Advocacy program so he could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Fire and safety drills must be performed every six months and documented for review by the Department.
(Page-3)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OMER, MAHAM	FACILITY NUMBER: 304313131
	VISIT DATE: 12/07/2021

NARRATIVE

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Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Fire and safety drills must be performed every six months and documented for review by the Department.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

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.

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.

Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

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 provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OMER, MAHAM	FACILITY NUMBER: 304313131
	VISIT DATE: 12/07/2021

NARRATIVE

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OTHER INFORMATION AND FORMS PROVIDED: (Posters were emailed to the Licensee)
Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.

Fire inspection from Orange County Fire Authority Fire inspection services have granted the fire clearance with specific instruction where the garage is not permitted for Day care.

The licensee does have a current roster of children in care. Six children's and employee files were reviewed and meets the requirements.

On Today's inspection facility is being cited for a Type " A "violation for operating over the licensed capacity by having 13 children in care in a Small Family Child Care home.
This is in violation of Title 22 Regulation 102416.5(a), which poses an immediate threat to the children's health and safety. See 809-D for Violations

Due to the Type A violation cited today, the licensee shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days.

An exit interview was conducted with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door/facility entrance.
End of Report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/07/2021 12:56 PM - It Cannot Be Edited

Created By: Ketki Desai On 12/07/2021 at 11:31 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OMER, MAHAM	FACILITY NUMBER: 304313131
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/08/2021 Section Cited CCR 102416.5(a)	1 2 3 4 5 6 7	(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This was not met as evidenced by: LPA oberved that 13 children were in care, in a Small family Child care home	1 2 3 4 5 6 7	The licensee stated she made a mistake by accepting additional children in care, as two children were coming in for make up days. She stated she will immediately ensure there are only 8 children in care as per the regulations of Small Family Child care home, Licensee stated they will email LPA a detailed explaination of
	8 9 10 11 12 13 14	This presents an immediate threat to the children's health and safety in care.	8 9 10 11 12 13 14	how she will correct the violation and remain within compliance of capacity and ratio regulations, by the end of today 12/8/21
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Thuy Ho

LICENSING EVALUATOR NAME:

Ketki Desai

LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC809 (FAS) - (06/04)

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