197494148-4-5-2021-30-CC-JLAO-BZSKSA-20210405080910

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494148
Report Date: 03/22/2021
Date Signed: 04/05/2021 08:09:30 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:	KASHNANYAN FAMILY CHILD CARE3		FACILITY NUMBER:	197494148
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	03/22/2021
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Anna Kashnanyan		TIME COMPLETED:	12:00 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	On 03/22/2021 at 11:00 am, Licensing Program Analyst (LPA) Judy Laureano conducted a Tele Visit through Face Time with licensee, Anna Kashnanyan for the purpose of an increase of capacity inspection for 7041 Goodland Avenue, North Hollywood, CA 91605. The purpose of this increase of capacity visit is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes. The licensee is applying for an increase of capacity; Large Family Child Care Home license for a max capacity of 14. A fire clearance was approved by LA County Fire Department and received at CCL on 3/16/202. LA County Fire Department signed and dated clearance on 3/12/2021. The applicant rent/leases the property with mother and landlord consent was received with a copy of the rent/lease agreement. The capacity of the Large Family Child Care Home is 14. Per the application, at this time, the ages the applicant wishes to provide services for are children 6 months old to 13 years old with the hours of operation of Monday- Saturday from 7:30 a.m. to 10:00 p.m. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

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: KASHNANYAN FAMILY CHILD CARE3	FACILITY NUMBER: 197494148
	VISIT DATE: 03/22/2021

NARRATIVE

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The home is a single story, 3 bedrooms, 1-bathroom house, with a living room, dining room, kitchen, laundry room a master bedroom with bathroom and den area. The front part of the home- 3 bedrooms, 1 bath, kitchen, dining room and living room area all have designated as OFF LIMITS. The main entry door will not be used to enter the facility. The laundry room located in the back of the home has been designated as off limits and remains locked during day care hours. A glass door was observed to separate the front house that is OFF LIMITS from the area that has been designated for the day care room.

The master bedroom and bathroom with den have been designated for the use of the day care. Parents access the day care through a side gate and the door leading to the side yard. The side gate was observed to have a lock and a top latch for safety.

Parents come through the side door and walk toward the home. Upon entering, a cemented area guides you to the back yard that has been designated for outdoor space for the day care. The yard was observed to have a variety of flowers lining up the side of the fence. LPA observed a variety of age appropriate outdoor toys, an empty water table, a small plastic slide for the children to use. At the end of the yard, a locked shed was observed, and licensee confirmed the shed remains locked during hours of operation. LPA discussed with licensee COVID-19 precautions regarding cleaning and disinfecting outdoor toys.

A French door was observed to have program information for parents to read. The doors lead you the den area that has been designated for the day care. LPA observed a variety of age appropriate toys and children’s size table and chairs. Variety of children’s books, toys and easels were observed in the space. A highchair was observed by the entrance next to the children’s cubbies. A television was observed to be mounted on the wall. LPA observed the necessary forms such as Parent’s Rights, facility License and program information on the wall. Fire extinguisher and carbon monoxide and smoke detector were observed in the space.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

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: KASHNANYAN FAMILY CHILD CARE3	FACILITY NUMBER: 197494148
	VISIT DATE: 03/22/2021

NARRATIVE

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Next to the den a door guides you the Master bedroom that has been designated for the day care. LPA observed a small closet to be safe for the children in care. Licensee confirmed that she only uses to store clothes. Licensee confirmed that the door will remain closed during the hours of operation. LPA observed 2 pack and plays and napping cots for the children to use. The space was observed to have a coach and a variety of children’s toys. Licensee confirmed that children nap in the Master bedroom/ day care room. LPA discussed safe sleep regulations and advised licensee to ensure she is familiar with the Safe Sleep regulations.

The bathroom that children in care can be accessed through the master bedroom/ day care room. LPA observed a sink, toilet and shower. Children’s size portable toilets (2) were observed in the space. Cabinets under the sink was observed to have extra supplies for the bathroom. LPA discussed COVID-19 precautions such as using paper towels in the bathroom and ensuring that high traffic areas are cleaned in between uses.

LPA observed a sliding glass door up 2 steps that separates the day care area from the front of the house. LPA observed a dinning room as soon as you open the sliding door. Dinning room area is OFF LIMITS to the children in care.

Kitchen is right next to the dinning room. The stove, refrigerator, sink and counter space area were observed and inspected. Due to COVID-19, LPA advised licensee to use disposable paper good. Kitchen is OFF LIMITS to the children in care.

Outside the kitchen, you are guided to the living room space. Bedroom 3 is next to the kitchen, bedroom 1 is across next to the main entrance. Bedroom 2 is next to the bathroom. LPA observed all area and licensee confirmed that all areas are OFF LIMITS to the children in care.
LPA discussed ensuring children and staff files are maintained with current information.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021

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: KASHNANYAN FAMILY CHILD CARE3	FACILITY NUMBER: 197494148
	VISIT DATE: 03/22/2021

NARRATIVE

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An exit interview was conducted over the phone and copy of this report was provided to applicant, Anna Kashnanyan. A follow up pre licensing visit will be scheduled if applicant is unable to submit corrections via email. A final decision of License issuance will be determined by the department unit licensing Manager.

The following was discussed with the applicant:
Applicant was made aware 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

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

Mandated Reporter Training: 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. Licensee was reminded of their responsibility to report suspected child abuse.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021

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: KASHNANYAN FAMILY CHILD CARE3	FACILITY NUMBER: 197494148
	VISIT DATE: 03/22/2021

NARRATIVE

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Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Be Maintained At The Facility - Family Child Care Home. Applicant was reminded that all documents for children's records must be kept current, as well as the roster and Drill Log additional forms can be obtained from the Department website: www.ccld.ca.gov

FORMS TO BE POSTED

· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster
Children’s records requirements:
· LIC 700 Identification and Emergency Information
· LIC 627 Consent for Emergency Medical Treatment
· LIC 282 Affidavit Regarding Liability Insurance
· LIC 9150 Parent Notification Additional Children in Care
· PUB 72- Family Child Care Consumer Guide
· LIC 995A Notification of Parent’s Rights
· CDPH 286 (Immunization Blue Card) Immunization record
FACILITY RECORDS:
· LIC 624B Unusual Incident/Injury Report
· LIC 9040 Child Care Facility Roster
· LIC 9052 Employee Rights,
· LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
· LIC 9149 Landlord Consent Form, if you plan to care for more than 6 children for a Small
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021

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: KASHNANYAN FAMILY CHILD CARE3	FACILITY NUMBER: 197494148
	VISIT DATE: 03/22/2021

NARRATIVE

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Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. 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 they come out to stay informed of any changes or updates to statutes and regulations. Applicant currently receives quarterly updates from CCLD/Childcare.

Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.

Applicant was informed about SAFE SLEEP PRACTICES and was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome). LPA provided applicant with SAFE to SLEEP handouts. Applicant was also informed that the provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.

·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week.
·In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
·A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

·Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

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: KASHNANYAN FAMILY CHILD CARE3	FACILITY NUMBER: 197494148
	VISIT DATE: 03/22/2021

NARRATIVE

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· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.
·Changes should be reported the to the Department as soon as they occur such as construction and remodeling. Telephone number changes and/or if you move from home.
·Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference
·Fire and safety drills must be performed every six months and documented for review by the Department. (Child care Fire Drill log provided to applicant)
·There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present. ·Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
·Saucer chairs, bouncers, walkers, or any similar items are prohibited. (Flyer example of what these items may look like given to applicant today)
·All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
·LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov (Applicant currently receives quarterly updates)

Applicant will not be providing IMS incidental medical services at this time. However, if she decides to do so she will inform CCLD-Child care Licensing and submit a plan prior to doing so.

IMS Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

Incidental Medical Services (IMS) policy was discussed 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

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021

LIC809 (FAS) - (06/04)

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