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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493676
Report Date: 03/21/2023
Date Signed: 03/21/2023 11:49:38 AM


Document Has Been Signed on 03/21/2023 11:49 AM - 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:PETROSYAN FAMILY CHILD CAREFACILITY NUMBER:
197493676
ADMINISTRATOR:PETROSYAN, MELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 645-0199
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:14CENSUS: 8DATE:
03/21/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:MELINE PETROSYAN, LICENSEETIME COMPLETED:
12:10 PM
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On 3/21/2023, Licensing Program Analyst (LPA) Loyce Phillips conducted a Case Management-Licensee Initiated visit with Licensee, Meline Petrosyan. This inspection is due to an application received for a room change within the large family childcare home. LPA observed 8 children in care with 2 staff members. Licensee guided LPA on a tour of the facility and intends to operate Monday through Saturday 7:00am to 5:00pm. Licensee will provide breakfast, lunch, pm snack and dinner to children in care.

Licensee does not have child-care insurance. Licensee resides in the home with spouse and 3 minor children. The areas identified on the facility sketch were inspected. This is a 4 bedroom, 3 bathroom home with 2 living rooms, kitchen, and formal dining room. Licensee has obtained certificate of occupancy from the City of Los Angeles to convert attached garage/storage room to a single family dwelling that has a laundry room and 1 bathroom. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition stored on the premises.

Licensee's home shares the same property as the back house with a different address. Licensee resides in the main house. The back house enters their home on the left side of the property and do not have access to the Licensee's home or middle back yard area.

Areas that are accessible to children are as follows: Converted garage/storage used for daily activities, napping, eating and toileting (see fire clearance).The bathroom located inside converted space. The left side of the backyard for walking to the middle yard. The middle back yard and front yard areas are available for outdoor activities

The off-limits areas are as follows: Living rooms 1 and 2, kitchen, formal dining room and entire upstairs area which includes 4 bedrooms and 2 bathrooms. The laundry room located inside converted space, detached garage and right sides of the back yard.

809-C

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: 424-301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2023
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493676
VISIT DATE: 03/21/2023
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The converted space was inspected inside and out for safety, comfort, cleanliness, heating and ventilation. Poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children are inaccessible. LPA observed age appropriate safe toys inside and outside the home. Licensee advised; children will nap on cots. Licensee has a carbon monoxide and smoke detector that was tested and operating located in the laundry room. The fire extinguisher is located in the closet next to the kitchen purchased on 3/8/2023. Medications are stored upstairs inaccessible to children. Knives were observed in an upper kitchen cabinet drawer inaccessible to children. Cleaning products are kept in the laundry room inaccessible to children.

LPA reviewed with Licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 resources. 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. LPA provided Recently Approved Safe Sleep Regulations PIN 20-24-CCP.


809-C
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: 424-301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493676
VISIT DATE: 03/21/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. 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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletter and other important information communication platform.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cd.ss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Based on today's inspection, the facility is approved for a room change.

Exit interview conducted and report was reviewed with Licensee.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: 424-301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
LIC809 (FAS) - (06/04)
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