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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494156
Report Date: 03/17/2021
Date Signed: 03/17/2021 03:24:21 PM

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:DRMOYAN FAMILY CHILD CAREFACILITY NUMBER:
197494156
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
03/17/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
07:15 AM
MET WITH:Anna DrmoyoanTIME COMPLETED:
07:40 AM
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On 03/17/2021 at 7:15 am, Licensing Program Analyst (LPA) Judy Laureano conducted a Tele Visit through Face Time with applicant, Anna Drmoyoan for the purpose of an increase of capacity inspection of 8105 Vantage Avenue, North Hollywood, CA 91605. The purpose of this increase of the 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 requesting to increase her capacity; application for a large family childcare license with a max capacity of 14.

Per the application, currently, the ages the licensee wishes to provide services for are children birth to 10 years old with the hours of operations as 7:00 am to 6 pm seven days a week, Monday through Sunday. Applicant was informed that any changes to ages, hours and days of operations shall be submitted to the department for approval prior to initiation of changes.

The structure is a 1 bedroom, 1 bath, with a living room, dinning room and laundry room with a backyard unit located in the back of the lot. Licensee owns and lives in the back unit. The front unit has a different address, 8107 Vantage Avenue, North Hollywood, CA 91605. Licensee stated the front unit is currently empty Licensee toured LPA Laureano via Face Time through the residence and the grounds.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2021
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 6
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: DRMOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494156
VISIT DATE: 03/17/2021
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LPA Laureano observed the home to be enclosed and parents will use the front gate to enter the facility. LPA observed the gate to have two locks, a key entry and a latch at the top of the gate. The front yard is off limits to the day care. Licensee greets parents at the entrance of the gate and on rainy days, the driveway gate is opened to allow parents to drive in to the day care. A cemented driveway leads you to the second gate that has signage for parents. Licensee’s car was observed to be park under a canopy in front of the home.

Pass the gate, LPA Laureano observed the back yard where applicant has designated as the outdoor area for the day care. The yard is covered with artificial turf and a variety of outdoor age appropriate toys such as cars, bicycles and a play structure were observed. The outdoor area is partially covered, the covered area was observed to have children size tables and chairs available for children to use.

Upon entering the facility, on the side of the wall of the entry way, LPA observed information for parents to read. Pass the entry way, the kitchen was observed and inspected. The stove, refrigerator, sink and counter space area were observed and all sharp knives and objects have been locked and made inaccessible to the children in care. Due to COVID-19, paper towels and disposable paper goods were observed. All electrical outlets in the kitchen were covered. LPA observed the carbon monoxide and smoke detector in between the kitchen and living room/dining room area that has been designated as the day care space.

Next to the kitchen, the living room/dining room that has been designated as the main day care room was observed. As you enter the space, a safety gate was observed. Licensee confirmed that a wellness check is performed and logged for all children in the facility. LPA observed hand sanitizer and a touchless thermometer in the space as well as all the required posted information. The space was observed to have a variety of age appropriate materials such as children’s size table and chairs, plastic blocks, soft toys and a dramatic play area with a play kitchen.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: DRMOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494156
VISIT DATE: 03/17/2021
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LPA observed two highchairs and licensee confirmed that meals and snacks take place in the living room/dining room area. The space was observed to have a sliding door that lead to the back yard. Licensee confirmed the door is locked when not in use. The fire alarm pull station and fire extinguisher were observed in the space.

The bathroom that children will be using is located outside the living room/dining room area across from the kitchen. LPA observed a sink, toilet and shower. Cabinets under the sink were observed to have extra supplies for the bathroom. A cabinet above the toilet, high enough to be inaccessible to the children in care, was observed to have all cleaning supplies. LPA discussed COVID-19 precautions such as using paper towels in the bathroom and ensuring that high traffic areas are cleaned in between uses.

The laundry room was observed to have a top and bottom washer/dryer set and the electric panel was observed to be in space.

Bedroom 1 was observed to be located next to the laundry room. The bedroom has been designated as a day care room and used mainly for napping. LPA observed a pull out sofa, 2 cribs and 4 cots in the space. LPA discuss COVID 19 precautions regarding setting up the cots and cribs with enough distance, as well as storing and cleaning of the bedding in use. LPA Laureano also discussed the Safe Sleep regulations with licensee and information was emailed for reference.

An exit interview was conducted over the phone and copy of this report was provided to applicant, Anna Drmoyan. A final decision of License issuance will be determined by the department unit licensing Manager.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2021
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: DRMOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494156
VISIT DATE: 03/17/2021
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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.
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.

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
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2021
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: DRMOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494156
VISIT DATE: 03/17/2021
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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.

Safe Sleep Links: AAPhttps://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx


NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

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.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2021
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: DRMOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494156
VISIT DATE: 03/17/2021
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•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)
• 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, 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)
•Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
•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.
•Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

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 NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2021
LIC809 (FAS) - (06/04)
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