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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402218
Report Date: 05/10/2022
Date Signed: 05/10/2022 03:36:57 PM


Document Has Been Signed on 05/10/2022 03:36 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:MIKAELIAN FAMILY CHILD CAREFACILITY NUMBER:
197402218
ADMINISTRATOR:MARINA MIKAELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 966-0281
CITY:ENCINOSTATE: CAZIP CODE:
91316
CAPACITY:14CENSUS: 12DATE:
05/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:53 PM
MET WITH:Marina Mikaelian/LicenseeTIME COMPLETED:
03:45 PM
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Required-1 Year Visit Conducted In Armenian
On 05/10/22 Licensing Program Analyst (LPA) Silva Garibyan conducted an unannounced Required – 1 Year Inspection and was met by Licensee, Marina Mikaelian. Also present was Staff #1 (S1). Licensee and assistant are Armenian Speaking. Days and hours of operation are M-F 8:00 a.m. to 6:00 p.m..

LPA toured the home inside and outside and a census was taken. There were 12 preschool children present at the time of the visit. Current facility sketch was reviewed. Licensee’s home is a a one story home with 3 bedrooms, 2 bathrooms, kitchen/nook, living/dining room, and a detached activity room. Licensee understands children are not to nap or eat in the converted activity room. Licensee understands that children nap and eat in the living room or dining room in the house.


Outdoor play of children is conducted in the back yard which is well fenced. There is a pool in the rear yard, enclosed by a 5 foot, white wrought iron fence. The pool gate is located at the top end of the fence and was tested and observed to open away from the pool area, self close and self latch. The remaining sides of the pool are enclosed by property walls. There are windows with bars that that secure the windows and no access to the pool. Child care is mainly conducted in the living/dining room, two bedrooms, kitchen/nook area. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There are no firearms or ammunition on the premises.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MIKAELIAN FAMILY CHILD CARE
FACILITY NUMBER: 197402218
VISIT DATE: 05/10/2022
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There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. LPA observed the fire drill log. The fire drills are done every month. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 626-8424.

There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee.

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 complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 03/06/2020. Licensee’s pediatric CPR/First Aid expires on 02/03/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

Incidental Medical Services (IMS) are / are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.


SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
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: MIKAELIAN FAMILY CHILD CARE
FACILITY NUMBER: 197402218
VISIT DATE: 05/10/2022
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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.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC809 (FAS) - (06/04)
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