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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313935
Report Date: 11/24/2021
Date Signed: 11/24/2021 02:37:33 PM

Document Has Been Signed on 11/24/2021 02:37 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:TAK, SEYEFACILITY NUMBER:
304313935
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/24/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Licensee Ms. Tak, Seye TIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Desai, Ketki conducted an unannounced In-person Case Management. License initiated inspection for a change in capacity at the existing Family Child Care home. LPA met with Licensee Ms. Tak, Seye, present at the site, there were no children present at the time of inspection. Licensee has provided her work experience as a Director, for five years, qualifying for a Large Family Child care home provider. Licensee received her License for a Small FCCH in October 2021.
Licensee gave a tour of the home.

A review of the Facility Personnel Report Summary indicates all adults, residing in the home who require caregiver background check clearances are cleared.

Licensee is requesting a Large family childcare home license. Per Licensee, operation hours will be Monday to Friday, 9:00 AM to 6.00 PM. Licensee states that she will care for Preschool age children (2-4 years old only .

This is a single story home which consists of three bedrooms, two bathrooms, living room, kitchen, dining room, office, attached garage, front yard (not fenced), side yard (fenced) and backyard(fenced). There is a Fire place in the designated day care area, with a safe barrier in front (wooden book shelf) making the area
in accessible.

All areas identified on the facility sketch that the children will use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. Including a Land line & Cell phone is also used for Day care communication. The home has a central Air /Heating system. The A/C unit is in the area inaccessible to children ( side yard of the home ) (Page-1)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/24/2021
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: TAK, SEYE
FACILITY NUMBER: 304313935
VISIT DATE: 11/24/2021
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Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The licensee states (that 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: Licensee has designated three bedrooms, kitchen, one bathroom, right hand side yards and detached garage as off limit areas. Licensee has installed a chid safety gate at the end of the bathroom making the three bedrooms and one bathroom inaccessible to children. Licensee has also installed safety gates at the kitchen entrances on both sides, making the area inaccessible to children. There is a fire place in the living area with a safe wooden book shelf. Side yards have a safety gate at each end, making it inaccessible to children. There is no direct access to the attached garage from the home, therefore it is inaccessible to children.

Licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA also observed COVID19, precautions at the facility, with required postings, temperature checks upon arrival, social distancing and activities being held in small groups.

Areas Designated for Day care activities: Licensee have designated the dining area / Living room / Office area /one bathroom and back yard for Day care activities. Parents and children shall enter through the Left side entrance from the front yard to the designated Day care room, there is a ring bell installed to gain access.

The Living area was observed to have age appropriate activities (Arts / Crafts) and educational items , the room has tables and chairs for additional activities. Living area is large and spacious. During nap time cots are arranged for children. Linens are provided by the parents and taken home for weekly washes.

Licensee has assistants including herself so children are supervised at all times. Office area is designated as an Isolation area for a sick child and Teacher's office area.

The bathroom designated for day care use was observed to be safe and free of hazardous items. Bathroom has a small step stool so children can reach the sink tap. There is also a changing station for the younger preschool age children. . (Page-2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2021
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: TAK, SEYE
FACILITY NUMBER: 304313935
VISIT DATE: 11/24/2021
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OUTDOOR PLAY AREA: Backyard / Patio is designated for outdoor play area, it is fenced and has concrete and grass flooring with sufficient shade, it has age appropriate outdoor toys.

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

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.

Licensee states that she provides Breakfast/ Lunch along with in-between snacks for children in care. If food is brought from children’s homes, those containers shall be labeled with child’s name and properly stored or refrigerated.

Licensee has completed the required Pediatric First Aid and CPR which expires 9/5/2023 There are first aid supplies available. Licensee has also completed the required Preventative Health and Safety training with Nutrition and Lead poisoning component.


The following was discussed with the applicant: Individuals who are 18 years of age or older living or working in the home must be fingerprinted cleared prior to being present in the facility. LPA provide applicant with website for Live-Scan locations oag.ca.gov/fingerprints/locations for all adult complete LIC 9163. If adult is fingerprinted cleared and associated to another facility, licensee must submit a Criminal Record Transfer Request (LIC 9182) or Exemption Transfer Request form (LIC 9188). Contact Licensing Office (714)703-2800 ask for Personnel ID#, fax Criminal Background Transfer Request form (LIC 9182 or LIC 9188) with copy of a valid identification issued by State or Federal Government and Criminal Record Statement (LIC 508) to fax # (714)703-2831 prior to hiring adult. Failure to complete the clearance process or license association for any adult resident or assistant will result in a civil penalty assessment against the license.

LPA reviewed Unusual Incident Report (UIR) form (LIC 624B)-advised to contact Licensing Officer of the Day within 24 hours and complete the UIR within seven days by faxing LIC624B to (714)703-2831.

Licensee was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov (3)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: TAK, SEYE
FACILITY NUMBER: 304313935
VISIT DATE: 11/24/2021
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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



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 garage is not permitted for Day care.

The facility was complying for a (Large Family Child Care Home) with Title 22 Regulations at the time of inspection. A license will be issued after final review, in the event additional requirements are needed, the Licensee will be notified.

On today’s inspection environment was observed to have a safe, healthful with comfortable accommodation, furnishing and equipment’s.

An exit interview 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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4