197417520-5-2-2019-30-CC-MPIN-BBSMWA-20190502095800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417520
Report Date: 05/02/2019
Date Signed: 05/02/2019 09:58:10 AM

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:	ASATRYAN FAMILY CHILD CARE		FACILITY NUMBER:	197417520
ADMINISTRATOR:	ANAIR ASATRYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 855-8682
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91401
CAPACITY:	14	CENSUS: 8	DATE:	05/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	07:30 AM
MET WITH:	Anair Asatryan		TIME COMPLETED:	10:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Marina Pilossian conducted an unannounced annural random inspection. LPA met with licensee and explained the purpose of the visit. LPA and licensee toured the facility inside and outside on 5/2/19 at 7:30am. LPA observed 8 children (2 infants, and 6 pre-school age) with the licensee and licensee's assistant who is also licensee's mother present with the children. Facility operations are Monday to Friday from 7 AM to 6 PM. LPA verified association to the facility of all the adults that were present during the visit and all were associated. Licensee has no pets. Adults living in the home include the licensee, and licensee's mother. Minor's living in the home include licensee's 12 year old daughter. Licensee is Armenian speaking. The visit was conducted in Armenian. The facility is a one story home with 3 bedrooms, 2 bathrooms, master kitchen, a small kitchen, a dining area, and a living room and a play room in the back yard attached to the detached garage. Child care is mainly conducted in the living room, a dining room, one of the bedrooms( across from the living room), and the play room. Licensee indicated that children dine in the living room . The detached garage in converted to an activity room. Licensee understands that no eating and napping is allowed in the detached garage.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina Pilossian	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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: ASATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197417520
	VISIT DATE: 05/02/2019

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

There is a pool in the backyard. LPA observed the pool fencing to be 5 feet high. The fence is made white mesh fence that enclosed the entire pool. There is only 1 gate in the fence. The gate was tested and observed to be self-closing, self latching and swings away from the pool area. LPA observed an entrance to the pool from the hallway from the outside that walks through a storage area into a room that has a double door to the pool and windows to the pool with direct access. LPA observed the white mesh fence around the pool on all sides covering the pool. Children do not have access to the back yard. LPA observed a gate with locks that was locked. Licensee reports she has no firearms or weapons in the home.

The following are the off limit areas; two bedrooms, the master bathroom and the master kitchen and the kitchen . Outdoor play of children is conducted in the front backyard which is well fenced LPA observed a working smoke detector, fully charged 2A10BC fire extinguisher, carbon monoxide detector and a working telephone. There was good lighting and ventilation at the facility as well. All electrical outlets were covered with plastic covers. All detergents, cleaning supplies are stored in well latched cabinets. Sharp objects, including knives are stored away from children’s reach and were inaccessible to children. Medications are stored away from children’s reach. LPA inspected the bathroom utilized by children and it was clean and orderly. Per the licensee, there are no firearms on the premises.

LPA observed a well -stocked first aid kit, age appropriate indoor /outdoor toys and cribs/mats/cots for napping.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina Pilossian	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: ASATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197417520
	VISIT DATE: 05/02/2019

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

Update on Incidental Medical Services:

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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)/ (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

LPA discussed and provided the safe sleep for baby pamphlet. Each infant shall be constantly supervised and under direct visual observation by an adult person at all times. Under no circumstances shall any infant be left unattended. In order to visually observed and supervise sleeping infants there should be no obstruction to the view of the infants, which could include transparency walls and/or half walls. LPA recommend that infants sleep safest in crib with no bumpers, pillows, blankets, or toys, and on their backs, and every sleep time counts to reduce the risk of SIDS and other sleep related causes of infant death.

Licensee 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

Exit interview and a copy of this report was printed and provided to the licensee during the inspection.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina Pilossian	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: ASATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197417520
	VISIT DATE: 05/02/2019

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Licensee has current pediatric CPR/First Aid certificate expires in 08/05/2020. Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , facility roster, Emergency Disaster Plan (LIC610a).

A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card.

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina Pilossian	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4