197419462-12-2-2019-30-CC-SGAN-BJGS8M-20191202123923

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419462
Report Date: 03/26/2019
Date Signed: 12/02/2019 12:39:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	HOMEWORK CLUB		FACILITY NUMBER:	197419462
ADMINISTRATOR:	DEMIRCHIAN, KRISTINE		FACILITY TYPE:	840
ADDRESS:	6051 BELLAIRE AVENUE		TELEPHONE:	(818) 606-7658
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	30	CENSUS: 20	DATE:	03/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Kristine Demirchian, licensee/director		TIME COMPLETED:	05:00 PM

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	This is an electronic version of a manual report created 03/26/19. Due to a consistency check issue with the FAS database, a FAS Version of the Facility Evaluation Report could not be provided. Licensee will be provided an electronic version of this site visit at a later date. Manual/typewritten report was provided (809S signed by the licensee is in the file). Licensing Program Analyst (LPA), Silva Garibyan met with the director/licensee Kristine Demirchian and conducted an Annual Random visit. LPA toured and inspected the after-school program in accordance with the facility sketch on 03/26/2019 at 3:30 p.m. Facility is currently licensed for a capacity of 30 children. The facility is located on the Monlux Elementary School campus in classroom 40. The Main entrance to the School is located on Bellaire Ave. Sign-in is required for all visitors and is completed inside the main office. The program children are kept separate from all other areas and other children at all times. LPA observed 20 children present at the facility. There were six teachers on the premises along with the director. The following were observed during this visit: 1. Teacher/child ratio; 2. Care and supervision of children in care; teacher/child interaction; 3. Availability of drinking water to children both indoors and outdoor 4. Cleanliness of facility and children's toys/equipment; cushioning under outdoor equipment. 5. Cleanliness of bathrooms, operation of toilets and sinks. . 6. Inaccessibility of chemicals and toxins to children in care 7. Sign in/out sheets; postings; emergency disaster drill logs. The after school program cares for children in grades Kindergarten through Fifth grade. After school Page 1 of 3

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2019

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HOMEWORK CLUB	FACILITY NUMBER: 197419462
	VISIT DATE: 03/26/2019

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

Senate Bill 792: that prohibits a person from being employed or volunteering at a child care facility if he or she has not been immunized against influenza, pertussis and measles and Assembly Bill 290 (Alejo, Chapter 734, Statutes of 2013). Staff immunization records are up to date.

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

The licensee was informed 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

On March 26, 2019 the facility has been found operating within substantial compliance per the California Health & Safety Code(s) and Title 22 Regulation(s).

A Copy of this Report and Notice of Site Visit were provided to the licensee.
An Exit interview was conducted.

Page 3 of 3

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HOMEWORK CLUB	FACILITY NUMBER: 197419462
	VISIT DATE: 03/26/2019

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

dismissal, Kindergarteners and First graders are picked up by a teacher from their classrooms and brought to room 40. Staff who remain inside the classroom accepting second grade children and above, will sign these children in as they arrive. All children are signed out by the child's authorized representative
8. Storage of children's belongings/Napping equipment.
9. The teachers have current Pediatric CPR/First Aid training to expire in 08/2020.
10. Sample of children's files were reviewed for accuracy and completeness.
11. Sample of staff files were reviewed.

Children bring their own snacks. Snacks also are provided by the Elementary School cafeteria and are available to all children on campus until 6:00 pm.
The licensee has permission by the school to use the playground as needed. The outdoor equipment was inspected for cushioning material, age appropriateness & good repair. Required shaded areas, drinking water availability & fencing were inspected. Water fountains are available on the playground for use by children. Play area was inspected for safety, potential hazards, & inaccessibility to bodies of water.

The following was discussed:

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

Page 2 of 3

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3