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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493669
Report Date: 08/10/2023
Date Signed: 08/10/2023 03:48:24 PM

Document Has Been Signed on 08/10/2023 03:48 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:ABBASI FAMILY CHILD CAREFACILITY NUMBER:
197493669
ADMINISTRATOR:HAJRA ABBASSIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 747-9723
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
08/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Hajra AbbasiTIME COMPLETED:
03:00 PM
NARRATIVE
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On 8/10/23 at 11:00 am Licensing Program Analyst (LPA) Maria Rendon arrived to 7541 N Claybeck Ave, Abbasi Family Child Care to conduct an unannounced inspection. Upon arrival LPA was greeted by Adult #1and informed LPA that Licensee Hajra Abbasi will arrive shortly. While holding an infant child, Adult #1 guided LPA on a tour of the home. A census of the facility was taken and LPA observed 1 infant and 2 staff. Adult #1 informed LPA that she was taking care of her grandchild. Licensee arrived at the facility at 11:10 AM and LPA introduced herself and informed Licensee that the purpose for the visit was to conduct an inspection.

Licensee guided LPA to a back house which has it's own Facility License #197494350. LPA requested a copy of the children's roster and Licensee informed LPA that she is currently not running her day care because of low enrollment. Licensee stated that the children that she had in her day care are now part of the facility in the back house. Licensee was not able to provide LPA a child roster with her facility number, instead licensee provided a roster belonging to the facility located in the back of the property.

A Type B deficiency is being cited today based on LPA observation, interview, and record review in accordance with the California Code Regulations, Title 22, see LIC 809D.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A
copy of this report, notice of site visit, and appeal rights were discussed and left with Licensee Hajra Abbasi , whose signature on this form confirm receipt of these documents.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
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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Document Has Been Signed on 08/10/2023 03:48 PM - It Cannot Be Edited


Created By: Maria Rendon On 08/10/2023 at 02:32 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ABBASI FAMILY CHILD CARE
FACILITY NUMBER: 197493669

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/10/2023
Section Cited
CCR
102417(8)

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102417 Operation of A Family Child Care Home (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidence by:
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Licensee informed LPA that currently she does not have children in her daycare and Licensee filled out and LIC 9211 Inactive Status at the time of the visit
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Based on observation, interview, record review, the licensee had five infants in care, which
poses immediate Health and Safety, or
Personal Rights risk to persons in care.
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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:Lisa Rios
LICENSING EVALUATOR NAME:Maria Rendon
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023


LIC809 (FAS) - (06/04)
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