197494656-4-8-2021-30-CC-LJCS-BZVNXG-20210408105106

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494656
Report Date: 04/05/2021
Date Signed: 04/08/2021 10:51:44 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:	KHACHATRYAN FAMILY CHILD CARE		FACILITY NUMBER:	197494656
ADMINISTRATOR:	KHACHATRYAN, KARINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 852-9463
CITY:	PANORAMA CITY	STATE: CA	ZIP CODE:	91402
CAPACITY:	14	CENSUS: 0	DATE:	04/05/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Karine Khachatryan		TIME COMPLETED:	10:32 AM

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 4/5/2021 at 9:00AM, Licensing Program Analyst (LPA) Lillian Casillas conducted an announced Pre-Licensing Tele-Inspection via FaceTime due to the COVID-19 pandemic Shelter-in-Place order in the State of California. The Applicant guided LPA Casillas on a tour of the inside and outside of the home. Hours of operation are Monday through Friday, 7:00am to 7:00pm. LPA observed 0 children and 1 adult (Margarita Manukyan) in the home. Applicant is applying for a Large Family Child Care Home with maximum capacity for 14 children. This is a single-story, 3 bedroom, 2 bathroom home with a kitchen, dining room, living room, front yard, backyard, storage room, and driveway. Childcare areas are: living room, bedroom #1, bathroom #1, and backyard. Off-limits areas are: bedroom #2, bedroom #3, bathroom #2, kitchen, dining room, storage room, front yard and driveway. Indoor Parents enter the home through a gate in the front yard and drop off their children at the front door. Applicant stated she will check the children's temperature using a touchless thermometer upon arrival. Children enter the home through the front door into the living room. In the living room, LPA observed a crib, toys, and educational materials posted on the wall. LPA observed a fire extinguisher (serviced 7/2020) and child safety plugs on all electrical outlets. Applicant stated she will keep children and facility records in this room in the TV cabinet that is secured with a child safety latch. Children will also eat on a large round table in the living room. In bedroom #1, LPA observed mats and a window covered with blinds. Applicant stated bedroom #1 will be used for napping. Bathroom #1 is located across the hallway. LPA observed 1 toilet and 1 sink. Applicant agreed to send LPA a picture of a child safety latch secured to the cabinet underneath the sink by 4/9/2021. The hallway that leads to bedroom #1 and the bathroom includes a functioning smoke detector and carbon monoxide detector. [CONTINUE ON PAGE 2]

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J Casillas	TELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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: KHACHATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494656
	VISIT DATE: 04/05/2021

NARRATIVE

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Indoors Off-Limits
LPA observed bedrooms #2 and #3 as well as bathroom #2. The bedrooms are accessed via the hallway.
LPA observed a child safety gate to keep children from entering the hallway from the living room without an
adult escort. LPA also observed a child safety gate to keep children from entering the dining room from the
living room. The kitchen is accessible via the dining room. LPA observed a well-stocked and organized
refrigerator. Applicant stated she will apply with a food program to provide meals to children in care. LPA also
observed a fire extinguisher (serviced 7/2020) in the kitchen.

Outdoor
LPA observed a large and enclosed (with a brick wall and gate) backyard. The concrete area is shaded and
LPA observed 3 rectangular tables for children to use for remote learning, activities, or meal-time. The other
half of the backyard is covered with artificial grass. LPA observed a slide, children's cars, and toys on the
grassy area. Children enter the backyard via the sliding door in the living room. LPA observed a door stopper
to prevent children from injuring their fingers with the sliding door. LPA observed a fire extinguisher (serviced
7/2020) mounted on the wall in the backyard.

Outdoor Off-Limits
The storage room is located in the backyard. Applicant stated the door to the storage room will remain locked
during hours of operation. Applicant stated the gate to the driveway will also remain locked during hours of
operation. The front yard is covered with mulch/wood chips and a concrete walkway that leads to the front
door. This area is enclosed with a brick wall/gate.

Items Needed for Correction by 4/9/2021:

Parent board: Parent's Rights, Facility Sketch, Emergency Disaster Plan
First-Aid Kit
Child safety latch on cabinet sink

[CONTINUE ON PAGE 3]

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J Casillas	TELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: KHACHATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494656
	VISIT DATE: 04/05/2021

NARRATIVE

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Discussed topics:
Baby Walkers/etc Prohibited. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucersand any other items that fall into that category. Health & Safety Code 1596.846(b) and (c).

Smoking Prohibited. Licensee 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. Health & Safety Code 1596.795(a).

SIDS & Shaken Baby Syndrome Awareness. Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and to prevent the Shaken Baby Syndrome, Never shake a baby!

High Chair & Car Seat Awareness. Licensee was also reminded that only children eating may be in high
chairs and that car seats are utilized only for transportation.

Parent’s Rights Notification. The "Notification of Parent's Rights" (PUB394) was discussed with the licensee and the licensee was advised that it must be posted in an area of the home accessible to parents. Title 22 102419.

Nutrition Requirement. Licensee was made aware of AB 290, commencing January 1, 2016, requiring at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university. Health & Safety Code 1596.8661.

[CONTINUE ON PAGE 4]

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J Casillas	TELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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: KHACHATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494656
	VISIT DATE: 04/05/2021

NARRATIVE

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Mandated Reporter Required. Licensee was made aware of AB 1207, commencing January 1, 2018, 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 Health & Safety Code 1596.8662.

Licensing Reports Given to Parents Required. Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a
conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly
enrolled child at the facility. Assembly Bill 633.

Incidental Medical Services Awareness. Incidental Medical Services (IMS) policy was discussed. For 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, Website: www.ada.gov/childqanda.htm
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. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

LPA advised Applicant to follow and remain updated with COVID-19 guidelines.

[CONTINUE ON PAGE 5]

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J Casillas	TELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: KHACHATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494656
	VISIT DATE: 04/05/2021

NARRATIVE

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An exit interview was conducted with Applicant on 4/5/2021 at 10:32AM and a copy of this report (LIC809) was sent to Applicant via email. Applicant agreed to reply to the email in lieu of a signature. Applicant agreed to submit the corrections listed on PAGE 2 by 4/9/2021. The licensing determination of this application will be reviewed with the Licensing Program Manager for final resolution.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J Casillas	TELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC809 (FAS) - (06/04)

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