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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493662
Report Date: 06/10/2021
Date Signed: 06/11/2021 09:57:09 AM

Document Has Been Signed on 06/11/2021 09:57 AM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:NIK FAMILY CHILD CAREFACILITY NUMBER:
197493662
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
06/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:18 AM
MET WITH:Fatemeh NikTIME COMPLETED:
03:45 PM
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On 06/10/21 Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced prelicensing inspection. Licensee submitted an application for a Large Family Childcare Home, increase in capacity.

Upon arrival LPA was greeted by Fatemeh Nik (Licensee). LPA observed 4 toddlers and 1 infant, licensee minor son and adult daughter . The home is a 3 bedroom 2 bath single story home LPA toured home and observed living room which is on limits and sun/garden type room behind the living where care is currently being provided. Licensee stated upon increasing of capacity she will also use the space in the living room for care to accommodate additional children.

There is a fire extinguisher (210A 10 B-C) in the sun/garden room area where care is currently being provided. Licensee will insure fire department provides yearly inspections of extinguisher. LPA observed the parent board on the wall in the area where care is currently being provided. LPA observed smoke detector and carbon monoxide detector in sun/garden room There is an additional smoke detector located in the hallway of the home.

Upon observing kitchen LPA observed poisonous/hazardous material under kitchen sink hazardous to children. LPA observed sharp knives accessible and hazardous to children.

LPA toured the entered the hall area and inspected bathrooms which contained hazardous/poisonous material to children. All 3 bedrooms that are off limits to children doors were unlocked and the master bedroom door was open. LPA did not observe any visual hazards in bedrooms.

LPA observed backyard area to free of any visual hazards.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2021
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NIK FAMILY CHILD CARE
FACILITY NUMBER: 197493662
VISIT DATE: 06/10/2021
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Proof of corrections have been discussed with applicant and the following must be provided before an increase in capacity will be allowed:

· Mandated Reporter completion Certificate for all individuals providing care for children

· T.B. Test for all adults in the home

· CPR & First Aid Card (licensee and anyone that will supervisor the children when the licensee isn’t present)

· Lead Poising Prevention Certificate ( www.cdph.ca.gov/programs/clppb) or (www.emsa.ca.gov)

· LIC 508

Licensee must submit this documentation to the Regional Office by the close of Business on 06/14/21

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NIK FAMILY CHILD CARE
FACILITY NUMBER: 197493662
VISIT DATE: 06/10/2021
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Informational Materials for Licensee:

Baby Walkers/etc Prohibited. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Health & Safety Code 1596.846(b) and (c).

Provider Information Notices (PINs). Licensee was informed that PINs are newsletters informing and updating Licensees about Community Care Licensing Division Regulations. Licensee was made aware that the PINs can be located on the California Department of Social Services webpage at https://cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

Criminal Record Review. Licensee was made aware that all individuals working, volunteering, or residing in the licensed facility are required to obtain a criminal record review. Title 22 Regulations 102370(d).

Criminal Record Review Violation. Licensee was made aware that if there is an individual observed to be working, volunteering, or residing in the home without obtaining a criminal record review the licensed facility will receive a citation of deficiency and an immediate assessment of civil penalties of $100 per violation per day for a maximum of (5) days by the Department or may result in a denial of the license application or a suspension/revocation of license. Title 22 Regulations 102370(e) and 102370 (f).

Facility Records. Licensee was given a copy of the LIC 311D, Forms/Records to Keep in Your FCCH, informing the applicant about the required documents to be maintained in the facility for employees, children, on the Parent Board. The Licensee was also advised on how to access forms and regulations for FCCH’s online at www.cdss.ca.gov.
Applicant also was informed children records and facility roster must be kept for 3 years and advised that all public reports must be kept for review. Forms and Regulations available at: www.ccld.ca.gov.

Fire disaster drills Licensee has been informed that fire drills are to be conducted at least once every 6 months and a log must be kept.

Smoking Prohibited. Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. Health & Safety Code 1596.795(a).
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NIK FAMILY CHILD CARE
FACILITY NUMBER: 197493662
VISIT DATE: 06/10/2021
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SIDS & Shaken Baby Syndrome Awareness. Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and to prevent the Shaken Baby Syndrome, Never shake a baby!

High Chair & Car Seat Awareness. Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

Parent’s Rights Notification. The "Notification of Parent's Rights" (PUB394) was discussed with the licensee and the licensee was advised that it must be posted in an area of the home accessible to parents. Title 22 102419.

Child Care Advocate Program Awareness. Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541; Email Address: childcareadvocatesprogram@dss.ca.gov

Immunizations Required. Licensee was made aware of SB 792, commencing September 1, 2016, prohibiting a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza (optional), pertussis and MMR (Measles, Mumps, and Rubella). Exemption were also discussed. Health & Safety Code 1596.7995.

Mandated Reporter Required. Licensee was made aware of AB 1207, commencing January 1, 2018, requires all licensed providers, applicants, directors, and employees to complete trainings (General and Child Care Provider) as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com Health & Safety Code 1596.8662.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NIK FAMILY CHILD CARE
FACILITY NUMBER: 197493662
VISIT DATE: 06/10/2021
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Incidental Medical Services Awareness. Incidental Medical Services (IMS) policy was discussed. 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, Website: www.ada.gov/childqanda.htm
Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

Lead Bill - Health & Safety Code 1596.7996. Licensee was made aware of AB 2370, requiring a licensed child day care center located in a building constructed before January 1, 2010, to have its drinking water tested for lead contamination and to let parents or legal guardians of children enrolled about the requirement to test and result of the tests.

New Immunization Requirement: Licensee was made aware of SB 277, commencing January 1, 2016, stating personal belief exemptions are no longer an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

Nutrition Requirement. Licensee was made aware of AB 290, commencing January 1, 2016, requiring at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university. Health & Safety Code 1596.8661.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NIK FAMILY CHILD CARE
FACILITY NUMBER: 197493662
VISIT DATE: 06/10/2021
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Licensing Reports Given to Parents Required. Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility. Assembly Bill 633.

Health Beverages in Child Care: Commencing in 2010, legislation was established regarding nutrition standards for beverages served in licensed child care centers and home. Only unflavored, unsweetened, nonfat (fat free, skim, 0%) or low-fat (1%) milk can be served to children over two years of age. No beverages with added sweeteners, natural or artificial, can be served, including sodas, sweet teas, juice drinks with added sugars, flavored milks and diet drinks. A maximum of one serving (4 to 6 oz. for 1 to 6 years old) of 100% juice will be allowed per day. Clean and safe drinking water must always be available, including meals and snacks. Assembly Bill (AB) 2084
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
LIC809 (FAS) - (06/04)
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