Pre-licensing visit·January 3, 2025

On 01/3/2025, Licensing Program Analyst (LPA) Anna Chan conducted an announced, in-person Pre-Licensing inspection for a relocation of a Large Family Child Care home (FCCH) to this new location on 21972 Summerwind Ln, Huntington Beach CA. Applicant is relocating from a previous licensed FCCH, LIC # 304314219. LPA met with applicant Reham,Boshra, who provided LPA a walk-through of the home. A review of the Facility Personnel Report Summary indicates 4 adults and 1 minor living in the home. The adult residents received caregiver background check clearances or exemptions as required by the Department. The applicant is requesting a relocation for a Large Family Childcare Home license. Per the applicant, operation hours will be 7:30 AM- 5:00 PM, Monday through Friday. Care and supervision will be provided to children ages newborn (infants) to 12 years old. For the purposes of licensing, an infant is defined as any child 0 to 24 months of age. All areas on the Facility Sketch LIC999 were inspected, including but not limited to, off-limits areas. The facility is a 2-story home. The facility has 4 bedrooms, 2.5 bathrooms, a living room, a dining room, a kitchen, backyard (fenced), and a storage room located in the backyard. There is one fireplace in the living room barricaded by a hard mesh covering and one fireplace in the day care area barricaded by mesh covering and blocked by toy shelves. There is a small fountain about 4ft high located in the front porch area of the home. Page 1 of 10 Based on the Facility Sketch LIC999 submitted, areas off-limits to children and parents are as follows: Applicants has designated the second floor which consists of; 4 bedrooms, 2 bathrooms as off limits. On the first floor are the dining room, living room, garage and storage room as off limits. The applicant has placed a retractable mesh baby gate at the entrance of the dining room/living room and second floor to ensure inaccessibility. Storage room was observed locked, and the licensee was informed storage room must be locked at all times during hours of operation. Applicant stated garage is off-limit and will not be used for child care. The applicant understands that licensing staff may have access to off-limits areas during inspection visits if necessary. Areas Designated for Day Care Activities: The applicant has designated day care area next to the kitchen, the kitchen, 1 bathroom located in the hallway from the day care area as indoor day care for children. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation, and heating. The children\342\200\231s bathroom was observed to be safe and free of hazardous items. The designated childcare areas were observed to have age-appropriate toys and educational items. Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant stated that there are no poisons on the premises and LPA did not observe any. The applicant was advised that any poisons must be locked with a key or combination lock. The applicant stated that there are no weapons or firearms on the premises. LPA informed the applicant that when firearms are present, they must be locked and stored separately from the ammunition per CCR 102417(g)(4)(C). Page 2 of 10 The pressure gauge on the KD143-210ABC fire extinguisher indicates fully charged, as indicated on the service tag observed. Smoke and carbon monoxide detectors were tested and are operable. 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 replaced as needed. The pressure gauge on the 2A-10BC fire extinguisher indicates fully charged, as indicated on the service tag. The fire extinguisher is located inside the hallway closet between the daycare area and the children\342\200\231s bathroom. OUTDOOR PLAY AREA: Outdoor play activities will be conducted in the backyard. LPA observed age-appropriate play equipment to be free from hazards. There are no swimming pools on the premises. However, there is a 4ft fountain in the front porch and is in the off limit area. The applicant stated the parents have the option to bring meals from home or meals will be provided by applicant every Monday and Friday. The applicant was informed that if children bring food from home, the children\342\200\231s names must be labeled on their lunch bags and refrigerated/stored properly. Per the applicant, children will nap in the day care area. Children will nap on mats. The applicant understand that there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. The applicant stated that parents will provide linens and blankets for napping. The applicant stated that parents will provide diapers, lotion, wipes, and formula for the infants. Per the applicant, a changing mat will be used to change diapers. LPA advised the applicant to always supervise at all times when changing infant\342\200\231s diapers. A records review indicates the applicant completed the required Health and Safety Training with Nutrition and Lead Poisoning components. The applicant has a current (EMSA approved) Pediatric First Aid and Pediatric CPR certification that expires on 10/2026. A first aid kit is available at the facility located inside the closet in the the hallway between the day care area and the bathroom. Page 3 of 10 Per the applicant, there are no dual licenses at this address. The applicant was advised that the email address may be public information. In the absence of the licensee, a qualified adult must be present to supervise the children\342\200\224a qualified adult is an individual who has a valid and current Pediatric First Aid and Pediatric CPR certification, TB clearance and immunization, and valid criminal record clearance that is associated with the licensed facility. Annual fees must be paid by the due date, or a late fee shall be assessed and/or the License may be terminated. The Child Advocacy Program was discussed with the applicant. The applicant was advised to register for the program to receive quarterly reports and other information in a timely manner. To register email ChildCareAdvocatesProgram@dss.ca.gov. Reporting Requirements: 1. Changes should be reported to the Department as soon as they occur, such as construction, remodeling, telephone number changes, and/or moving out from your home. 2. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Each family childcare home must conduct fire drills and disaster drills at least once every six months. The licensee must document the date and time of each drill. This documentation must be kept at the facility for review by the Department. Page 4 of 10 No smoking, No Johnny jumpers, No saucer chairs: any other items that fall into that category are prohibited in the facility. Inspection Authority: All adults living and working in the home shall be made of aware of the Department\342\200\231s right to inspection authority, which includes but is not limited to the right to enter the home when children are being cared for, interview children and adults, and review documentation. Licensee must post each facility license number in all advertisements, publications, or announcements with the intent to attract clients. H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The applicant has submitted proof of immunizations. Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors, and employees must complete training as specified on mandated reporter duties. Training is available at www.mandatedreporterca.com . The applicant has completed the required mandated reporter training. Recertification is required every two years. Applicant AB1207 mandated reporter certification expires 08/28/2025 and 05/04/2024 The LPA advised the applicant on how to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.cdss.ca.gov/inforesources/community-care-licensing . LPA reviewed and issued the LIC311D \342\200\234Forms/Records to Keep in Your Family Child Care Home\342\200\235 and provided the forms below. Note: Children and Staff records must be kept and updated as necessary and must be available for review by the Department. Page 5 of 10 CHILDREN FORMS/RECORDS - Children\342\200\231s files must contain the following completed documents and information: Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Affidavit Regarding Liability Insurance (LIC 282), Parent Notification Additional Children in Care (LIC 9150), Notification of Parent\342\200\231s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), California School Immunization Record (CDPH 286), Individual Infant Sleeping Plan (LIC 9227), Risk and Effects of Lead Poisoning (PUB 515), Family Child Care Consumer Awareness Information (LIC 9212), Blood Glucose Testing Consent/Verification (LIC 9222), Nebulizer Care Consent/Verification (LIC 9166), Acknowledgment of Receipt of Licensing Reports (LIC 9224). FACILITY FORMS/RECORDS - Facility files must contain the following documents/information: Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Unusual Incident/Injury Report (LIC 624B), Child Care Facility Roster (LIC 9040), Property Owner/Landlord Notification (LIC 9149), Property Owner/Landlord Consent (LIC 9149), Entrance Checklist \342\200\223 Family Child Care Homes (LIC 126), Forms/Records to Keep In Your Family Child Care Home (LIC 311D), Safe Sleep Flyer-What Does A Safe Sleep Environment Look Like?, Never Ever Shake A Baby Brochure. STAFF FORMS/RECORDS - Facility files must contain the following documents/information: Personnel Records as specified in Title 22 Regulations 102416.1, Notice of Employee Rights (LIC 9052), one Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108) per provider, Copy of Pediatric Cardiopulmonary Resuscitation & Pediatric First Aid (CPR & First Aid Certification), Proof of pertussis, measles, and Tuberculosis (TB) vaccines, Proof of influenza vaccine (or documentation of exemption), Proof of Mandated Reporter Training certificate, Copy of Criminal Background Clearance Transfer Request (LIC 9182), Copy of Criminal Record and Exemption Transfer Request (LCI 9188). Page 6 of 10 Criminal Record Clearance Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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. Landlord Consent APPLICANT RENTS THE HOME: The applicant provided proof of signed Landlord Consent (LIC9149) INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME \342\200\223 You are required by law to post the following: Facility License (LIC 203), Notification of Parent\342\200\231s Rights Poster (PUB 394), Earthquake Preparedness Checklist (LIC 9148), Emergency Disaster Plan (LIC 610A) California Car Seat Law (PUB 269). A Notice of Site Visit (LIC 9213) must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type \342\200\234A\342\200\235 deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department\342\200\231s order to correct a Type \342\200\234A\342\200\235 deficiency must be posted for 30 days during the hours that children are in care. OTHER INFORMATION AND FORMS PROVIDED: (Posters were emailed to the Licensee) Capacity Handouts for a Large Family Child Care Home was provided. Page 7 of 10 The following was discussed with the applicant : Incidental Medical Services Plan (IMS APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm Incidental Medical Services (IMS) - Family Child Care Homes. Review of records to be maintained: LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children\342\200\231s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. Safe Sleep LPA discussed the safe sleep regulations with the applicant 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. LPAs also informed the applicant 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. Page 8 of 10 Megan\342\200\231s Law On this date, 01/03/2025, the California Attorney General - Megan\342\200\231s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. Subscribe to CCLD important information Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. 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. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years. The Large Family Child Care Home was in compliance with Title 22 Regulations at the time of inspection. In the event additional requirements are needed, the applicant will be notified . A license will be issued once all requirements are met. Page 9 of 10 MyChildCarePlan.org Applicant was informed of the MyChildCarePlan.org site, 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. Exit Interview Appeal rights were provided. Exit interview conducted and report was reviewed with the applicant Reham Boshra. End of Report Page 10 of 10