<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493543
Report Date: 06/13/2024
Date Signed: 06/13/2024 03:02:02 PM

Document Has Been Signed on 06/13/2024 03:02 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:DAVTYAN FAMILY CHILD CAREFACILITY NUMBER:
197493543
ADMINISTRATOR/
DIRECTOR:		DAVTYAN, NARINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 579-5882
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
06/13/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Narine DavtyanTIME VISIT/
INSPECTION COMPLETED:
03:15 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
On 6/13/24 at 9:45 am Licensing Program Analysts (LPA), Jeanine Lipsey conducted an unannounced Required Annual Inspection and was met by Licensee Narine Davtyana. LPA observed 7 children in care being supervised by 2 staff. Days and hours of operation are Monday through Friday 7am to 6pm. Entrance Checklist was provided to the applicant. Applicant stated that a cell phone with active service in the home will be the main contact number while children are in care. Affidavit for Liability Insurance are in the children files.

LPA Lipsey observed the following required postings: License, LIC 610A Emergency Disaster Plan, PUB 394 Notification of Parents’ Rights Poster, and LIC 9148 Earthquake Preparedness Checklist. LPA advised all LIC9213 Notice of Site Visits shall be posted for 30 days after each site visit. LPA advised, any licensing report documenting a Type A citation must be posted for 30 days. LPA advised a disaster drill log shall be posted with disaster drills completed at lease every six months.

LPA toured the home. This is a one story, four bedroom, 2 bathroom home with living/dining room, kitchen, and attached garage.

The areas that are accessible to children: are the living room (play room), 2 bedrooms, and i bathroom and the backyard for outdoor activities.

LPA did not observe any poisons present during the inspection. Cleaning compounds, Medication, detergents and other hazardous item were made inaccessible to children. Per applicant, there are no firearms, or weapons on the premises. LPA observed the home to be free from defects or conditions which may endanger the children.

Page 1 of 4

Betty BellTELEPHONE:
Jeanine LipseyTELEPHONE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493543
VISIT DATE: 06/13/2024
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
LPA observed fully stocked first aid kit. LPA Lipsey observed a working a carbon monoxide detector in the hall way and four smoke detectors located in the bed rooms, living room, hallway, and dining area. LPA was able to hear a successful test. A fire extinguishers, 2A10BC was observed, located in the hallway closet near the front door and was last purchased on 6/13/24. Electrical outlets were observed to be inaccessible to children in care with the use of plug covers. The home was observed to be clean and orderly with heating and ventilation. LPA observed safe toys, play equipment, and materials. There are no stairs in the home. LPA did not observe fire place or open faced heater.

LPA observed the outdoor area to be fenced and free from hazards. LPA observed a children's play equipment to be safe and free on hazards. Licensee ensures that children in care are always supervised. Capacity as specified on the license is being maintained. LPA did not observe any bodies of water on the premises.

CPR/first aide training was completed on 8/16/22 and the Mandated Reporter Training was Completed on 12/8/22. Staff #1 was missing CPR and record of TB test.

The licensee provided proof of control of property. Because the rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the licensee confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/

.

Page 2 of 4

SUPERVISOR'S NAME: Betty BellTELEPHONE:
LICENSING EVALUATOR NAME: Jeanine LipseyTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493543
VISIT DATE: 06/13/2024
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
 On this date, 8/1/17 the California Attorney General - Megan's Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at: www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and­resources/safe sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Page 3 of 4

SUPERVISOR'S NAME: Betty BellTELEPHONE:
LICENSING EVALUATOR NAME: Jeanine LipseyTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493543
VISIT DATE: 06/13/2024
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 was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, deficiencies are cited. Technical advisories discussed.

The following issues must be corrected by the plan of correction due date:

1. Technical violation small Bear attached to the pacifier, licensee removed pacifier and will give to the parent at pick up.

2. Technical violation Licensee will complete Roster LIC 9040 and send proof by 6/20/24.

3. Type B Staff 1 is missing proof of TB test. Licensee will send proof via text or email by POC date of 6/20/24.

4. Type B Staff 1 missing proof of CPR, will send proof via text or email by POC date of 7/4/24.

Exit interview conducted and report was reviewed with the licensee Narine Davtyan.

A notice of site visit was given and advised Licensee that it must remain posted for 30 days.

Page 4 of 4

SUPERVISOR'S NAME: Betty BellTELEPHONE:
LICENSING EVALUATOR NAME: Jeanine LipseyTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 06/13/2024 03:02 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 06/13/2024 at 01:53 PM
Link to Parent Document Below:
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: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493543

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview record review the licensee did not comply with the section cited above in 1 out of 1 staff is missing proof of TB test which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/20/2024
Plan of Correction
1
2
3
4
 Licensee will send proof via text or email by POC date of 6/20/24.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview record review, the licensee did not comply with the section cited above in staff does not have proof of CPR training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/04/2024
Plan of Correction
1
2
3
4
Staff will take training and will send proof via text or email by POC date of 7/4/24.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Betty Bell
TELEPHONE:
LICENSING EVALUATOR NAME:Jeanine Lipsey
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024


LIC809 (FAS) - (06/04)
Page: 5 of 7