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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493676
Report Date: 06/24/2022
Date Signed: 06/24/2022 12:02:51 PM


Document Has Been Signed on 06/24/2022 12:02 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:PETROSYAN FAMILY CHILD CAREFACILITY NUMBER:
197493676
ADMINISTRATOR:PETROSYAN, MELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 645-0199
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:14CENSUS: 11DATE:
06/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Meline Petrosyan, Licensee TIME COMPLETED:
12:15 PM
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On 6/24/2022 at 8:40am Licensing Program Analyst (LPA), Denise Miranda conducted an unannounced Annual Required Inspection and was met by Licensee, Meline Petrosyan. Also present were 2 Licensee’s Assistants, and 11 childREN (who 1 was infant and 2 school-age). An updated LIC279 Application form was provided to LPA showing the days and hours of operation is from Monday – Saturday 7Am to 7PM. Also, licensee provided an updated LIC279B.

Licensee, agreed to submit a new sketch showing the off-limit and on-limit of the house.


Per Sketch the licensee's home is a two story single family home with 4 bedrooms, 3 bathrooms (two upstairs and one downstairs), a family room, dining room and living room, that is converted to a day care room, kitchen, and a fire place in the main living room, and attached garage.

The following areas are designated as follows and Licensee confirmed the: Living room, dining room, bathroom##1 and backyard.

The off-limit : Off limit areas include the entire 2nd floor, family room, and the attached garage with laundry room, storage room located inside of the garage.
LPA observed gate barricading: the stairs that lead to the 2nd floor making it inaccessible to the children (bottom and top of the stairs), also, LPA observed a gate between dining room and kitchen.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2022
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: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493676
VISIT DATE: 06/24/2022
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LPA observed a fireplace barricade with screen located at the living room. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Safe toys and play equipment are observed. Furniture was observed with no loose or sharp parts, clean and in good repair

The home has working telephone service and LPA confirmed the phone number is (818) 645-0199.

There are currently 1 infant in care and 2 elementary school.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats were not observed at facility. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a all children’s files present in care today and observed files were complete. Licensee’s Mandated Reporter Training was completed on 12/27/2021, Mandated Reporter training is due for renewal on 12/27/2023. Licensee’s pediatric CPR/First Aid completed on 12/15/2021 and is due for renewal on 12/15/2023, There 2 currently employees at the facility.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.


LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
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: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493676
VISIT DATE: 06/24/2022
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/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-and-resources/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.

Staff interview conducted and documented at 11:17am

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee. Report, Appeal Rights and Notice of Site Visit were given to Licensee.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
LIC809 (FAS) - (06/04)
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