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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313745
Report Date: 02/13/2024
Date Signed: 02/14/2024 05:21:42 PM

Document Has Been Signed on 02/14/2024 05:21 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SELIAN, HITOMIFACILITY NUMBER:
304313745
ADMINISTRATOR:SELIAN, HITOMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 801-2517
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
02/13/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:TIME COMPLETED:
01:30 PM
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A 3-year random inspection was conducted at the facility by Licensing Program Analyst (LPA) Navar. At 10:10 AM LPA arrived at facility and met with assistant Hiroko Shimada, caring for 2 infants asleep in car seats. 1 infant was strapped and covered with a blanket with a pacifier attached to a lanyard attached to their body while sleeping in the car seat. 2nd infant was strapped in car seat and covered with a blanket. Assistant stated that Licensee Hitomi was at the park with the 6 other children. Assistant stated she will call her home. Licensee Hitomi Selian and assistant Misato Takahshi arrived at facility with 5 children and 1 infant at 10:30AM. The license was operating within the licensed capacity as specified on the license with 8 children total. Licensee's operation hours are 9:00AM-5:00PM M-F. Off on Holidays.

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today’s inspection, LPA Navar toured the inside and outside areas identified in the facility sketch as accessible to childcare children. The facility is a two-story home. Off limits areas the kitchen and entire second floor and are made inaccessible by means of baby safety locks and safety gates. The childcare area consists of 2 living rooms, dining room, and bathroom located next to kitchen and dining room. Licensee stated the children's primary area for childcare is the living room.

The facility has a fireplace inside the living room that is inaccessible to children by a screwed in frame. There is a working carbon monoxide, smoke detector, and a fire extinguisher in the home that meet statutory and State Fire Marshall standards. Last fire/disaster drill documented on 1/5/2024. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. The licensee stated there are no firearms and/or other dangerous weapons in the facility, and none were observed during today's inspections.
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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SELIAN, HITOMI
FACILITY NUMBER: 304313745
VISIT DATE: 02/13/2024
NARRATIVE
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The home has age-appropriate toys for the ages served. LPA verified there is a working telephone service (cellular service). The licensee stated, they use the back yard for outdoor play, LPA inspected the back yard, and it was found to be incompliance. There are no bodies of water at the facility.

The licensee has a current roster of children in care. 5 children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700), Immunization records, Affidavit Regarding Liability Insurance (LIC282), Consent for Emergency Medical Treatment (LIC627), Notification of Parent’s Rights (LIC995A) and found to be in compliance. Licensee Hitomi stated she has not documented the 15-minute safe sleep log and has not completed the LIC 9227 Individual Infant Sleeping for the 3 infants in care.

The licensee Pediatric CPR/First Aid certification expires 1/28/2026. 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 pertussis, measles for licensee and assistants 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 2 assistants were in compliance and have completed training.

The licensee understands she 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, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.

CCLD website www.ccld.ca.gov 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. The 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.
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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
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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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SELIAN, HITOMI
FACILITY NUMBER: 304313745
VISIT DATE: 02/13/2024
NARRATIVE
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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.

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.

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/.



Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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

Licensee was reminded that all adults 18 and over, 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 Child Care Center. 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.
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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
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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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SELIAN, HITOMI
FACILITY NUMBER: 304313745
VISIT DATE: 02/13/2024
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In the areas that were evaluated, 1 Type B deficiencie was observed in the California Code of Regulations, Title 22, Division 12 at the time of the visit. See LIC 809D page for deficiencies.

LPA Navar informed licensee Hitomi that this report dated 2/13/2024 documents 1 Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care. See LIC 809D page for deficiencies.

Also, LPA Navar informed licensee Hitomi to provide a copy of this licensing report dated 2/13/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.

A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the licensee Hitomi. A Notice of Site Visit was given and must remain posted for 30 days. Failure to comply with postal requirements shall result in an immediate civil penalty of $100.

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

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.

End of Report

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/14/2024 05:21 PM - It Cannot Be Edited


Created By: Karen Navar On 02/13/2024 at 12:31 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: SELIAN, HITOMI
FACILITY NUMBER: 304313745

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(h)
Infant Safe Sleep
Car seats shall only be used for transportation purposes and shall not be used for sleeping.

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. At arrival to facility LPA observed 2 infants strapped in and sleeping in car seats. The 2 infants were covered with blankets and 1 infant had a pacifier with a lanyard attached while sleeping.which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/13/2024
Plan of Correction
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Assistant took infants out of car seats immediatley. Licensee stated she will have conversation with assistant regarding safe sleep.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Judy Hanson
LICENSING EVALUATOR NAME:Karen Navar
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/14/2024 05:21 PM - It Cannot Be Edited


Created By: Karen Navar On 02/13/2024 at 12:31 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: SELIAN, HITOMI
FACILITY NUMBER: 304313745

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. During records review LPA was not able to review 3 infants in care 15 minute sleep log. Licensee stated she does not document 15 minute safe sleep. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/23/2024
Plan of Correction
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LIcensee stated she will document 3 days of sleep logs and email to LPA.LIcensee also stated she will have conversation with her 2 assistants regarding safe sleep log.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Judy Hanson
LICENSING EVALUATOR NAME:Karen Navar
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024


LIC809 (FAS) - (06/04)
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