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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494483
Report Date: 08/18/2022
Date Signed: 08/18/2022 03:01:51 PM

Document Has Been Signed on 08/18/2022 03:01 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:BARSOUM FAMILY DAY CAREFACILITY NUMBER:
197494483
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
08/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Nadia BarsoumTIME COMPLETED:
12:30 PM
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On 8/18/2022 Licensing Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection and was met by Nadia Barsoum, Licensee. LPA observed 6 children in the home with 1 additional adult during the inspections. Days and hours of operation are Monday through Friday, 6:00 a.m. to 9:00 p.m. Currently licensee does not have any infants, children under the age of 12 months, in care.

LPA toured the home inside and outside and a census was taken. Home is a single story dwelling, there has been no change to the physical layout to the facility. Licensee confirmed the play room, dinning room area and ½ bathroom are accessible to the children in care. All other rooms are OFF LIMITS and made inaccessible to the children. LPA reminded licensee that all doors that lead to the areas designated as off limits need to be closed and locked during the hours of operations.

Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. No windows or doors have direct access to the pool area. No poisons were observed during the inspection.


There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. They are located under the sink with a safety latch, making them inaccessible. Licensee confirmed detergent and additional cleaning supplies are kept in the kitchen cabinet under the sink- safety latch added making the content inaccessible.

There is a decorative fire place in the living room and outdoor seating area. There are two working fire extinguishers located in the play room/day care room and dining room area. LPA observed licensee test the smoke detector, carbon monoxide detector in the home. Facility has adequate heating and ventilation for safety and comfort. Home has 2 steps that led to the play room, LPA observed a safety gate at the bottom of the 2nd step.

Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (310) 482-7810.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2022
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BARSOUM FAMILY DAY CARE
FACILITY NUMBER: 197494483
VISIT DATE: 08/18/2022
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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.
LPA reviewed a sample of children’s files and observed files were incomplete with proof of immunization missing from 2 out of 6 files. LPA issued a technical Violation and licensee agrees to ensure necessary documents are in the children’s file by 9/2/2022. Licensee’s Mandated Reporter Training was taken on 5/17/2022. Licensee’s pediatric CPR/First Aid taken on 5/28/2022 A review of records indicates that all employees and/or volunteers have immunization records on file. LPA reviewed all other immunization records such as pertussis and measles. Licensee will ensure all documents pertaining to assistant are available for LPA’s review, specifically the LIC 9052. 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.


Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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.

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.

Exit interview conducted and report was reviewed with the licensee Nadia Barsoum.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
LIC809 (FAS) - (06/04)
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