197409984-5-11-2022-30-CC-SGAN-CEBVPP-20220511163704

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197409984
Report Date: 05/11/2022
Date Signed: 05/11/2022 04:38:37 PM

Document Has Been Signed on 05/11/2022 04:38 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MKRTICHIAN AND GLUKHOVSKIY FAMILY CHILD CARE		FACILITY NUMBER:	197409984
ADMINISTRATOR:	MKRTICHIAN,J.& GLUKHOVSKIY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(808) 463-8780
CITY:	ENCINO	STATE: CA	ZIP CODE:	91316
CAPACITY:	14	CENSUS: 13	DATE:	05/11/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Julia Glukhovskiy/Licensee		TIME COMPLETED:	04:45 PM

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On 05/11/2022 Licensing Program Analyst (LPA) Silva Garibyan conducted an unannounced Required- 1 Year Inspection and was met by Licensee, Julia Glukhovskiy. Also present was/were Staff #1 (S1). Days and hours of operation are M-F 8:00 AM – 6:00 PM.

LPA toured the home inside and outside and a census was taken. There were 13 children present (including one school age child, no infants) at the time of the visit. Current facility sketch was reviewed. The facility has 3 bedrooms, 3 bathrooms, kitchen , dining area, detached garage, living room, and family room with a bathroom. Off limit areas include the licensee's bedroom, and the bathroom in the master bedroom, the kitchen, the living room, and the dining room. Children utilize the detached garage for activities only, and the family room for napping and eating. LPA explained to the licensee that no eating or napping is allowed in the detached garage. Licensee understands and will comply. There is no swimming pool or other bodies of water on the premises. 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.

There is no swimming pool or other bodies of water on the premises. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. 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 (808) 463-8780. Page 1 of 3

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

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: MKRTICHIAN AND GLUKHOVSKIY FAMILY CHILD CARE	FACILITY NUMBER: 197409984
	VISIT DATE: 05/11/2022

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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 05/11/22. Licensee’s pediatric CPR/First Aid expires on 01/24. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

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.

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.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

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: MKRTICHIAN AND GLUKHOVSKIY FAMILY CHILD CARE	FACILITY NUMBER: 197409984
	VISIT DATE: 05/11/2022

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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.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

LIC809 (FAS) - (06/04)

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