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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417320
Report Date: 01/29/2025
Date Signed: 01/29/2025 02:41:24 PM

Document Has Been Signed on 01/29/2025 02:41 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:AL-DHAIF FAMILY CHILD CAREFACILITY NUMBER:
197417320
ADMINISTRATOR/
DIRECTOR:		AL DHAIF, IBTISAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 235-9139
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
01/29/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Ibtisam Al DhaifTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Tatiana Bickham conducted an unannounced annual inspection to the above facility on 1/29/2025.  LPA arrived at the facility at 1:30 PM, identified self and met with Ibtisam Al Dhaif, Licensee, who guided LPA on a tour of the facility.  LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. There were 6 children and 1 staff present when LPA arrived. Facility capacity is in compliance for a small/large Family Child Care Home. Hours of operation are Mon-Fri 7:00 AM - 6:00PM.

All areas identified on the Facility Sketch were inspected.

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.

Due to time constraints the Annual visit will be completed on a future date.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Ibtisam Al Dhaif, Licensee.
SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Tatiana Bickham
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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