197492855-6-17-2019-30-CC-SGAN-BD8LPL-20190617085606

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197492855
Report Date: 06/13/2019
Date Signed: 06/17/2019 08:56:11 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:	KHACHATRYAN FAMILY CHILD CARE		FACILITY NUMBER:	197492855
ADMINISTRATOR:	KHACHATRYAN, KARINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 390-0881
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	14	CENSUS: 9	DATE:	06/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Karine Khachatryan		TIME COMPLETED:	01:00 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	Licensing Program Analyst (LPA) Silva Garibyan conducted an unannounced annual/random inspection to the aforementioned facility. Upon arrival, LPA met with Karine Khachatryan, Licensee. LPA was guided on a tour of the facility inside and outside at 11:00 AM. There are no changes to the facility layout or to the off limit areas. Childcare is primarily conducted in the play room and children eat in the play room and nap in the bedroom in the hall way. Children's restroom is located in hall way near the nap room. Per licensee, the residents of the home are licensee and her adult sons. Licensee was present with 9 children ( including one infant, four school age children, and four preschoolers) and one assistant/licensee's son. The following was observed during this inspection: 1. All adults working or residing in the home are fingerprint cleared and associated. 2. There is no pool, spa or other bodies of water on the premises. 3. Per licensee, there are no guns or firearms in the home. None were observed. 4. The licensee maintains current roster. 5. The licensee maintains monthly disaster drills. 6. Children's records were reviewed. 7. The home is kept clean and orderly, with heating and ventilation for children's safety. 8. There are abundance of age appropriate children's toys and equipment that were observed to be in good repair. 9 The home is equipped with a fully charged fire extinguisher, smoke detectors and one carbon monoxide detector located in the hall way. 10. The children's bathroom was inspected for inaccessibility of chemicals and toxin that may be hazardous to the health and safety of children in care. 11. Licensee's and assistant's current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 01/2020). (Continued)

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019

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: KHACHATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197492855
	VISIT DATE: 06/13/2019

NARRATIVE

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12. Per licensee, there are no children currently enrolled who require Incidental Medical Services.
13. Mandated Reporter Training completed on 03/30/2018

The following were discussed with the licensee:

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

Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders.

Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

Licensee was reminded it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations. Licensee was also made aware that the quarterly updates are also in Spanish.

Exit interview was conducted and a copy of the report was provided

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019

LIC809 (FAS) - (06/04)

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