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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494307
Report Date: 10/03/2019
Date Signed: 10/03/2019 04:09:40 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:BEDOYAN FAMILY CHILD CAREFACILITY NUMBER:
197494307
ADMINISTRATOR:RUBINA BEDOYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 334-7415
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY:14CENSUS: 0DATE:
10/03/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Rubina BedoyanTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA’s) Stella Gutierrez and Lourdes Castellanos met with Rubina Bedoyan, Licensee for a re-location Applicant, for an announced Pre-Licensing inspection on 10/03/2019 at 2:00 p.m. Applicant was informed that we are going to tour the home for a pre-licensing requirement per title 22 regulations. Licensee provided LPA’s with a guided tour of the home inside and out.

Applicant was a prior licensee at Facility #198018578 for a capacity up to 14 and served ages 2-5 years old. The Licensee has requested to surrender the prior license for this new location and has been done so 09/23/2019. LPA's Stella Gutierrez checked for any outstanding fees and made sure that prior facility is longer active prior to today’s visit.

Areas identified on the facility sketch were observed and inspected.

This is a 1 story dwelling, 3-bedroom, 2-bathroom, Livingroom, kitchen, dining room front yard and back yard (fenced in). There are no bodies of water on the property. The home was inspected inside and out for safety, comfort, cleanliness, cell phone service, heating and ventilation, poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children. LPA observed age appropriate safe toys and napping equipment (cots) on the premises. Per licensee children will nap in the bedroom # 3


Fire extinguisher (Pro-210) is up to date and was purchased on 10/01/2019. Applicant has a working Smoke Detector / Carbon Monoxide located in bedroom #3. Tested and operating. An accessible First Aid Kit equipped with, cleansing pads healing ointment, bandages, gauze, and a digital thermometer.

The Applicant currently has one dog and one bird. The dog has been immunized with a rabies shot provided on file. Immunization date 09/25/2019 (repeat every 3 years) . The children will not interact with the dog or bird. Pets will be housed in inaccessible (living room) to the children in care during operating hours.

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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 8
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: BEDOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494307
VISIT DATE: 10/03/2019
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Interior:
Living room – Upon entering the home LPA’s, observed a fire place with no cover, sliding glass doors off to the North side off home leading to side yard free of hazards.

Kitchen/Dining room- Dining table/ sliding glass door leading to a side yard with open floor plan to kitchen with refrigerator (where labeled food will be stored for the children) open accessible drawer with knifes and accessible cleaner’s underneath Kitchen sink.

Bedroom #1- Located 1st door left when entering hallway. LPA’s observed with a lock on door that makes it inaccessible to the children.

Bathroom #1- Located 1ST door to right when entering the hallway with accessible hazards underneath the sink area.

Bedroom #2- Located 2nd door to left when entering the hallway. Bed and Chester drawers with a lock to make it inaccessible when children are in care.

Bathroom #2- Located in bedroom #3 with two working sinks, one working toilet and a shower and no accessible hazards. Shower is used for storage for children’s napping cots and other supplies for children.

Bedroom #3- Located last door to the right of entering hallway Children’s main area of care/ Tables, cubbies, arts crafts and back door to back of room that leads to outdoor play are for children.

Exterior:

Front Yard- Fenced in and free of hazards with one large tree.

Back yard- LPA’s witnessed rocks in this area (less than two handfuls) Play equipment (swings, slide, tables, playhouse and small tyke toys).

Side yard- north of home which is accessible to dining area (fenced in from front yard)

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: BEDOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494307
VISIT DATE: 10/03/2019
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The following was discussed with Applicant/Licensee, Rubina Bedoyan:

Areas that are inaccessible to children are as follows:


Front Yard, Side yard, Living room, Kitchen, dining room, Bedroom #1, Bedroom #2, Bathroom #1.

Areas that are accessible to children are as follows:
Bedroom # 3 (main area) Bathroom #2, back play yard area located directly through back door of bedroom #3.

*Licensee stated that there are no fire arms which are kept in the premises.

Facility Administration: Pediatric First Aid and CPR expires 03/2020 for the applicant, immunizations are on file.


102416 (c) Complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

A certificate of completion of a course or courses in preventive health practices as defined in subdivision (a) or certified copies of transcripts that identify the number of hours and the specific course or courses taken for training. (8 hours required)

·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.
·Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The family

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC809 (FAS) - (06/04)
Page: 8 of 8
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: BEDOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494307
VISIT DATE: 10/03/2019
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day care home shall maintain documentation of the required immunization's 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.
·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 and remodeling.
·Telephone number changes and/or if you move from home
·Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
·Fire and safety drills must be performed every six months and documented for review by the Department.
·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.
·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.
·LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov


SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: BEDOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494307
VISIT DATE: 10/03/2019
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The applicant was informed 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 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: childcareadvocatesprogram@dss.ca.gov

AB 1207: Beginning on January 1, 2018, this law 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 completed mandated reporter training on 05/20/2019. Followed by the general training module, the Child Care Providers module is a three-hour training that includes eight sections. Licensee completed the additional three-hour training on 07/06/2019.




Safe Sleep Links:
AAP: https://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

Applicant will be providing Incidental Medical Services for children in need. Plan of Service is in facility profile.

Update on Incidental Medical Services (IMS):


Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department.
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: BEDOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494307
VISIT DATE: 10/03/2019
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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. For further IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

SIDS & SHAKEN BABY SYNDROME INFORMATION (discussed) flyer provided.
LPA's provided safe sleep flyer and discussed safe sleep practice. Infants must be placed on their backs and must be physically checked every 15 minutes to gauge temperature and ensure they are breathing.

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
· Immunization record
· PUB 72- Family Child Care Consumer Guide
· LIC 995A Notification of Parent’s Rights
CDPH 286 (Immunization Blue Card)

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: BEDOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494307
VISIT DATE: 10/03/2019
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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
· Copy of your deed or lease/rental agreement
· Documentation of Fire and Disaster drills
· Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandated reporterca.com – renewed every two years

A packet that includes the documents listed above and a ratio flyer, were provided and discussed.

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.


SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: BEDOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494307
VISIT DATE: 10/03/2019
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The following items are pending prior to licensure to be completed by 10/10/2019

1. Children’s outside play are leads to side area making dining and kitchen area accessible to children through if sliding doors are left open. LPA’s advised Applicant to place a small linked fence to make the area inaccessible and send picture as proof to email provided.

2. LPA’s observed knifes and cleaners in kitchen area. Applicant removed the cleaners to hallway cabinet in hall area. LPA advised applicant to place a latch on this closet to make inaccessible. Send picture to email. Applicant removed knifes during todays visit and place in a top tier shelf in kitchen.

3 LPA’s observes cleaner’s underneath bathroom #1 sink and latch needs to be placed to make inaccessible to children in care. Send picture to email provided for proof of correction.



An exit interview was conducted, and a copy of this report was provided to the Applicant. Final decision of License issuance will be determined by the department unit Licensing Program Manager.
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC809 (FAS) - (06/04)
Page: 2 of 8