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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494711
Report Date: 12/02/2020
Date Signed: 04/07/2021 09:24:11 AM

Document Has Been Signed on 04/07/2021 09:24 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:OHANA FAMILY CHILD CAREFACILITY NUMBER:
197494711
ADMINISTRATOR:OHANA, INBALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 254-4913
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
12/02/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Inbal OhanaTIME COMPLETED:
09:30 AM
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On 12/02/2020 at 8:30 am Licensing Program Analyst (LPA) Judy Laureano conducted a Tele Visit through Zoom with Applicant, Inbal Ohana for the purpose of a pre-licensing inspection of property1617 S. Sherbourne Drive, Los Angeles, CA 90035. The purpose of this pre-licensing visit is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

The application is for a large family childcare license with a max capacity of 14. The applicant owns the home with her husband David Ohana and their two adult daughters, Lynn and Adi Ohana therefore landlord consent is not required. Review of application and applicant stated her, her husband and two children are the only residents of the home. Applicant has two dogs who have up to date vaccines. Both dogs will be kept away from the children during facility’s operations.

Per the application, currently, the ages the applicant wishes to provide services for are children 18 month to 5 years old with the hours of operations as 8 am to 3 pm. Applicant was informed that any changes to ages, hours and days of operations shall be submitted to the department for approval prior to initiation of changes.

The structure is a single-story home with 3 bedrooms, 2 bathrooms, a living room, dining room, kitchen, breakfast nook area and detached garage. Applicant toured LPA Laureano via zoom through the residence and the grounds. LPA Laureano observed the front yard, no enclosures and a front porch. Applicant stated they are looking into adding a door to the existing side wooden gate to allow parents to enter the facility
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2020
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: OHANA FAMILY CHILD CARE
FACILITY NUMBER: 197494711
VISIT DATE: 12/02/2020
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LPA Laureano observed the main entrance of the facility with small entry way area has been secured for the safety of children. To the left of the entry was is the living room that will be used for the day care for children. Two couches, two cabinets have been safety proof and secured to the wall. Applicant stated that children will be napping and eating in the living room/dining room area. Dining room has a table with chairs and a small cabinet which has been safety proof. A smoke and carbon monoxide detector can be found outside the living room, LPA Laureano observed applicant test the detector. All electric outlets are covered, in both the living room and dining room.

Kitchen was observed as having upper and lower cabinets. The stove, refrigerator, sink and counter space area were observed and inspected. Content of cabinets and drawers observed, knives are secured in top drawers next to the sink and stove; both were observed to be secured with a latch. The kitchen leads you to a breakfast nook that has a small table and chairs. A fire extinguisher can be found near the cabinet. The area has three pantry style cabinets that are secured with latches. The first one has the washer and dryer, second one has food and snacks and the third one has additional food and snacks, Clorox wipes and sanitizers.

Outside the kitchen, to the right, a barn style sliding door separates the kitchen area from the bedrooms. Small hallway with two large lining closest were observed. In one of the closets, applicant has the First Aid kit. A child size couch was observed, and applicant stated the area will be used for additional napping area if needed or an isolation area when children are sick. To the right of the small hallway the bedroom 1 and bedroom 2 were inspected and have been designated as an off-limit area and will remain locked during hours of operation, which makes it inaccessible to children in care. Both bedrooms have a smoke/carbon monoxide detector.

Outside the small hallways LPA Laureano observed the bathroom. A toilet, sink, cabinet and bathtub were observed to be free of hazardous materials. Cabinets was observed to have a safety latch.
To the left of the bathroom a Master bedroom and bathroom and have been designated as an off-limit area and will remain locked, which makes it inaccessible to children in care. Applicant stated that both dogs will remain in the Master bedroom during hours of operations. A smoke/carbon monoxide detector was observed in the Master bedroom
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020
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: OHANA FAMILY CHILD CARE
FACILITY NUMBER: 197494711
VISIT DATE: 12/02/2020
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Outdoor Area/Back Yard: LPA Laureano observed the back yard where applicant has designated as the outdoor area for the day care. The yard has a wooden gate that leads to the driveway to the Sherbourne Drive. A large green toolbox that is closed is secured is in the entrance of the driveway. The area is covered with artificial turf grass. To the right of the yard a Pergola covers outside chairs and a small table. To the left of the yard, a BBQ grill and a storage area is fenced and made inaccessible to the children in care.

Detach Garage: LPA Laureano observed the detached garage that has a covered outside area with two large sliding door that leads you to the room. A ceiling fan and smoke/carbon monoxide detector were observed. Applicant states this area will be used for day care activities. Age appropriate materials such as books, children’s kitchen and furniture were observed. LPA Laureano informed applicant that children are not to nap or eat in the garage, it is only to be used for activities. LPA observed a working sink with cabinets that are being used to store additional children’s materials. A refrigerator was observed, and LPA advised applicant to secure it with a latch for safety of the children in care. The Garage has a bathroom that has a toilet, sink and shower. Cabinet under sink has extra paper towels and toilet paper. Applicant will secure shower door with a latch to avoid children accessing the shower.
A small staircase lead to a loft where applicant has designated as office space and is off limits to the children in care. A safety gate is secured in the bottom of the stairs which makes it inaccessible to the children in care.

The following items are pending prior to licensure to be completed by 12/11/2020 or when RO receives fire clearance. A follow up visit through zoom will be scheduled.
Kitchen
1. Safety latches on bottom cabinets.
Bedrooms
1. Safety Knob to ensure that bedroom doors will remain inaccessible to the children in care.
Hallway: Safety latch on large linen closets
Garage
1. Safety latch on refrigerator door and shower door.
Materials needed: a pack and play or napping mat.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: OHANA FAMILY CHILD CARE
FACILITY NUMBER: 197494711
VISIT DATE: 12/02/2020
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The following was discussed with the applicant:
Applicant 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 in order 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

Immunization: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training 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. Licensee was reminded of their responsibility to report suspected child abuse.

Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations. Applicant currently receives quarterly updates from CCLD/Childcare.


Applicant 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. Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: OHANA FAMILY CHILD CARE
FACILITY NUMBER: 197494711
VISIT DATE: 12/02/2020
NARRATIVE
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Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Be Maintained At The Facility - Family Child Care Home. Applicant was reminded that all documents for children's records must be kept current, as well as the roster and Drill Log additional forms can be obtained from the Department website: www.ccld.ca.gov

FORMS TO BE POSTED


· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster
Children’s records requirements:
· LIC 700 Identification and Emergency Information
· LIC 627 Consent for Emergency Medical Treatment
· LIC 282 Affidavit Regarding Liability Insurance
· LIC 9150 Parent Notification Additional Children in Care
· Immunization record
· PUB 72- Family Child Care Consumer Guide
· LIC 995A Notification of Parent’s Rights
· CDPH 286 (Immunization Blue Card)
FACILITY RECORDS:
· LIC 624B Unusual Incident/Injury Report
· LIC 9040 Child Care Facility Roster
· LIC 9052 Employee Rights,
· LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
· LIC 9149 Landlord Consent Form, if you plan to care for more than 6 children for a Small
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020
LIC809 (FAS) - (06/04)
Page: 7 of 7
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: OHANA FAMILY CHILD CARE
FACILITY NUMBER: 197494711
VISIT DATE: 12/02/2020
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Applicant was informed about SAFE SLEEP PRACTICES and was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome). LPA provided applicant with SAFE to SLEEP handouts. Applicant was also informed that the provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.

Safe Sleep Links: AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx


NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

Facility Administration:
·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week.
·In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
·A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

·Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)
· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.
·Changes should be reported the to the Department as soon as they occur such as construction and remodeling, telephone number changes and/or if you move from home.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: OHANA FAMILY CHILD CARE
FACILITY NUMBER: 197494711
VISIT DATE: 12/02/2020
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·Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference
·Fire and safety drills must be performed every six months and documented for review by the Department.
·There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.

·Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
·All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
·LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov (Applicant currently receives quarterly updates)

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020
LIC809 (FAS) - (06/04)
Page: 6 of 7