197494308-1-13-2022-30-CC-SGAN-CACV9S-20220104151448

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494308
Report Date: 01/04/2022
Date Signed: 01/13/2022 08:56:07 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:	YEPREMYAN FAMILY CHILD CARE		FACILITY NUMBER:	197494308
ADMINISTRATOR:	HASMIK YEPREMYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 517-8911
CITY:	NORTH HOLLYWOOD,	STATE: CA	ZIP CODE:	91606
CAPACITY:	14	CENSUS: 12	DATE:	01/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:19 PM
MET WITH:	Hamik Yepremyan/Licensee		TIME COMPLETED:	03:20 PM

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On 01/04/22 Licensing Program Analyst (LPA) Silva Garibyan conducted an unannounced Required-1 Year inspection and was met by Licensee, Hasmik Yepremyan. Licensee is Armenian speaking and the visit was conducted in Armenian. Days and hours of operation are M-F from 7:00 AM to 6:00 PM.

LPA toured the home inside and outside and a census was taken. Licensee was present with 11 preschool and one school age children and her assistant (licensee's mother). All areas identified on the facility sketch were inspected. Licensee’s home is a single story dwelling with four bedrooms, two bathrooms, living/dining room, family/day care room, kitchen. There is another Family Child Care Home(small) attached to the home with a different address, 12741 Victory Blvd., North Hollywood, CA 91606, license # 197494132. During today's visit, LPA observed the yard for the license # 197494308, address 12743 Victory Blvd., North Hollywood, CA 91606 and facility address 12741 Victory Blvd., North Hollywood, CA 91606 separated by a fence. Three bedrooms and one bathroom are off limits to the children in care. Children will eat and sleep in the living/dining room, family/day care room, and in the bedroom in the back. The children will have access to the bathroom located near the day care room. The main entry door is used to enter the facility. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include licensee and her mother. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. The kitchen cabinets and drawers were inspected for inaccessibility of toxins/chemicals, knives and other sharp objects which may be harmful to children in care. There are no firearms or ammunition on the premises. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. Per LIS the facility annual fees are current

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022

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: YEPREMYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494308
	VISIT DATE: 01/04/2022

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The home does not have a fireplace. There is a working fire extinguisher, smoke detector, and carbon monoxide. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 517-8911.

There are currently no infants in care. Licensee does not serve infants. LPA discussed Safe Sleep Regulations with licensee. Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. 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.

Licensee’s pediatric CPR/First Aid expires on 02/22/2022. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. Licensee is Armenian speaking and the Mandated Reporter Training is not available in Armenian at the time of this inspection. 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.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022

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: YEPREMYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494308
	VISIT DATE: 01/04/2022

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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.

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.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022

LIC809 (FAS) - (06/04)

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