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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493296
Report Date: 06/27/2019
Date Signed: 07/01/2019 09:50:51 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:ALEBYAN FAMILY CHILD CAREFACILITY NUMBER:
197493296
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
06/27/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Elizabeth Alebyan and Karine AlebyanTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit . The licensees have applied for capacity increase. LPA met with the licensees and toured the home inside and outside at 1:10 p.m. on 06/27/2019. The licensees were present with 3 children ( one infant). All areas identified on the facility sketch were inspected. Licensees' home is a single family, single story home (5 bedrooms, 3 bathrooms, living room, dining room, kitchen, a carport is constructed at the front of the home). The home was inspected inside and out. Family members residing at facility are: Licensees ( mother and daughter), spouse, and licensee's adult son. There is no pool, spa or other bodies of water on the premises. Main care is provided in the bedroom/play room accessible from the side of the home. Children have access to the bathroom in the bedroom. The four bedrooms and two bathrooms are off-limits. Children play in the back yard which is fenced. There are two entries to the house. The main entry door is not used to enter the facility. Children and parents use the entry to the bedroom/play room. Per licensees, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons First aid kit was observed and complete. LPA also observed Licensees' current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 04/2020). Licensee has an operating smoke/carbon monoxide detectors in the child care room as well as two operating and fully charged Fire Extinguisher. LPA observed the fire drill log. The fire drills are done every month. There is a fire place in the family room. Fire place has a screen, preventing access to the fire place. There is a dog in the facility. The dog has its own dog run. Licensees stated the dog's shots were up to date.

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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019
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: ALEBYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493296
VISIT DATE: 06/27/2019
NARRATIVE
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Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , Child Care Facility Roster (LIC9040), 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.
The following was thoroughly discussed with the licensee:

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. Licensees' 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
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

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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019
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: ALEBYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493296
VISIT DATE: 06/27/2019
NARRATIVE
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Capacity and Ratios: The licensee has applied for a capacity increase for a large family . The Max capacity is 12 with no more than 4 infants and a qualified assistant. Without a qualified assistant the license reverts back to the requirements for a small family childcare. Optional care may be provided for a max capacity of 14 children with no more then 3 infants, 2 school age children and a qualified assistant. School age children must be 1 age 6 yrs and 1 in Kindergarten.

Capacity increase is pending Fire clearance only. When Fire clearance has been received file will be submitted for increase approval.


The facility is operating in substantial compliance with the Title 22 Regulations at time of visit.
No violations were cited. A copy of this report along with a Notice of Site Visit were issued and explained to licensee.

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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019
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: ALEBYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493296
VISIT DATE: 06/27/2019
NARRATIVE
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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

Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Armenian speaking.

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

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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4