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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494247
Report Date: 10/24/2024
Date Signed: 10/24/2024 03:38:23 PM

Document Has Been Signed on 10/24/2024 03:38 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:YOUSEFI DANBALI FAMILY CHILD CAREFACILITY NUMBER:
197494247
ADMINISTRATOR/
DIRECTOR:		YOUSEFI DANBALI, MARYAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 619-4558
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
10/24/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:05 AM
MET WITH:Martan Tiysefu Dabali, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced annual inspection to the above facility on 10/24/2024. LPA arrived at the facility at 11:05 AM, identified self and met with Maryam Yousefi Danbali, Licensee, who guided analyst on a tour of the inside and outside of the facility. There were 13 children present at arrival. Present was 1 Staff (S1). LPA provided Licensee with a copy of the LIC125 Entrance Checklist to help facilitate the inspection. Facility operation hours are Monday to Friday from 7:00AM to 11:00PM.

During the inspection LPA called Language Services to interpret in the Licensee primary language. During the call Licensee declined to continue with the interpreter service.

The licensee provided proof of control of property.

The family child care home is a one-story dwelling, includes living room, dining room, kitchen, 3 bathrooms, 3 bedrooms, play room, sleeping room, laundry room and attached garage. Current facility sketch reviewed, and Licensee confirmed that play room, sleeping room, 1 bathroom (near sleeping room) are used for providing care and are accessible to children.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The children use the play room for child care activities and eating. There are tables and chairs, toys and play items that are safe, clean, and appropriate for the ages of the children. The napping room is used for sleeping. There are cribs, cots and bed linens available for children. LPA observed there were 3 cribs with mattresses that were too small for the cribs (photo taken). LPA advised license that the mattress need to fit the crib.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
Document Has Been Signed on 10/24/2024 03:38 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 10/24/2024 at 02:00 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: YOUSEFI DANBALI FAMILY CHILD CARE
FACILITY NUMBER: 197494247

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that the fire extinguisher was not the recommended size for the facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee stated they will purchase a fire extinguisher by the plan of correction due date 11/25/2024 and provide LPA with a copy of the receipt and photo.
Type B
Section Cited
CCR
102417(g)(9)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that the a written diaster plan was not readily availabe upon request during the inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee stated the will complete a. written disaster plan by the plan of correction due date and provide LPA with the original form by mail
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:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2024


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 10/24/2024 03:38 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 10/24/2024 at 02:00 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: YOUSEFI DANBALI FAMILY CHILD CARE
FACILITY NUMBER: 197494247

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)(4)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (4) Mattresses shall be made specifically for the size crib or play yard in which they are placed.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that the mattress did no fit the crib (photo taken) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee stated they will replace the mattresss for the 3 cribs by the plan of correction due date 11/25/2024 and provide LPA with the receipt and photos.
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in there was room additions built that were not on the current facility sketch which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licnesee stated they will provide an updated facility sketch floor plan and yard by the plan of correction due date 11/25/2024 and will provide LPA the original documents by mail.
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:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2024


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 10/24/2024 03:38 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 10/24/2024 at 02:00 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: YOUSEFI DANBALI FAMILY CHILD CARE
FACILITY NUMBER: 197494247

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 13 of 14 childrens files did not contain a affidavit signed by the parent which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee stated they will provided copies of the affidavits signed by each parent of the children enrolled in the faciliy by the plan of correction due date 11/25/2024 and provide LPA with a copy of the forms by email.
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:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2024


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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: YOUSEFI DANBALI FAMILY CHILD CARE
FACILITY NUMBER: 197494247
VISIT DATE: 10/24/2024
NARRATIVE
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The kitchen is next to the play room and made inaccessible with the use of child mesh gate secured to the walls. The licensee provides food for children in care. LPA advised Licensee that when food is brought to the facility it must be labeled with child’s name and stored properly. There is telephone service via a landline that is used during operation hours.

The outdoor play area is located in the side of the house, is fenced and there are no hazards to children present. LPA observed appropriate toys and other play equipment for children in care. LPA observed that the side yard leads to the another yard behind the house that is not accessible to children. Licensee has items a swing seat and planter box blocking the pathway to the back of the house. LPA advised licensee to block the area from the fence to the planter box (photo taken) to block entry to the back if the house.


Per Licensee, areas off limits to children and parents include: 3 bedrooms, 2 bathroom, laundry room, attached garage, and back yard and made inaccessible by use of door lock to the entrance to the area and by blocking the entrance to the back yard.

LPA did observe a front yard, per Licensee, the front yard is not used for child care activities. Children enter the home from the front door.

Per Licensee, there are no firearms, ammunition, or poisons on the premises. LPA advised Licensee if poisons are kept in the home, they must be in a locked storage area with a lock and key or a combination lock. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.



There are no pets on the premises.

LPA did not observe a fireplace or an open-faced heater.

LPA observed a working fire extinguisher 1:10A BC and advised Licensee the requirement is for a 210A-BC fire extinguisher. There combination smoke detector/ carbon monoxide detector (dining room) and adequate heating and ventilation for safety and comfort.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
Page: 6 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: YOUSEFI DANBALI FAMILY CHILD CARE
FACILITY NUMBER: 197494247
VISIT DATE: 10/24/2024
NARRATIVE
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There are currently no infants in care. 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.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Licensee was reminded that children in care are to be supervised at all times and made aware that children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

Capacity as specified on the license is being maintained.

Emergency Disaster Plan is not complete., Parent’s Rights Poster and the Facility License were observed to be posted.

LPA reviewed a sample of children’s files and observed files were incomplete and documented on the LIC857.

An emergency fire/disaster drill has been completed and documented within the last 6 months on 09/15//2024. Licensee’s Mandated Reporter Training was completed on 08/02/2023. Licensee’s pediatric CPR/First Aid expires on 01/23/2025.

There were 1 personnel record for LPA to review and observed files were incomplete and documented on LIC859. Staff #1 was missing proof of TB clearance and was not readily available upon request during the inspection.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
Page: 7 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: YOUSEFI DANBALI FAMILY CHILD CARE
FACILITY NUMBER: 197494247
VISIT DATE: 10/24/2024
NARRATIVE
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LPA reviewed with licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children's forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

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

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.



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 child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
Page: 8 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: YOUSEFI DANBALI FAMILY CHILD CARE
FACILITY NUMBER: 197494247
VISIT DATE: 10/24/2024
NARRATIVE
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To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care­ licensing/subscribe and select the Child Care option to receive email communication.

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.

The following Type B deficiencies for 102417(g)(1) Operation of A Family Child Care Home, 102417(g)(9) Operation of A Family Child Care Home, 102425(a)(4) Infant Safe Sleep, 102416.3(a)(6) Alterations to Existing Building or Grounds, 102417(m)(3) Operation of A Family Child Care Home and on the attached deficiencies page are being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 1.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.



Exit interview was conducted with Maryam Yousefi Danbali, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.


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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
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