197494748-4-15-2021-30-CC-LCAS-C24SQN-20210415140502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494748
Report Date: 02/23/2021
Date Signed: 04/15/2021 02:06:14 PM

Document Has Been Signed on 04/15/2021 02:06 PM - It Cannot Be Edited

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:	VARDANYAN FAMILY CHILD CARE		FACILITY NUMBER:	197494748
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	02/23/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Gohar Vardanuan		TIME COMPLETED:	11:00 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 2/23/2021 at 10:00 AM, Licensing Program Analyst (LPA) Lourdes Castellanos conducted a Pre-Licensing tele-inspection with applicant Gohar Vardanyan via Facetime due to the current public health crisis (COVID-19). This inspection is for the purpose of relocation. The applicant is currently licensed facility # 197494404 address 16300 Bermuda Street , Granda Hills, CA 91344 (front property). Licensee moved as of 12/27/2020 to the back house 16302 Bermuda Street, Granda Hill, CA 91344 on the same lot. Residing at home is licensee and husband. The Licensee’s husband Hamlet Tadevosyan provided translation during today’s inspection. LPA was guided on a virtual tour of the home (inside /outside). The licensee is applying for a Small Family Child Care License to operate Monday Through Friday 8:00am-5:00pm (Capacity 8). Upon arrival to the property, parents will walk up to the gate in front of the property and go through the left side of the front house to access the back house. Areas identified on the facility sketch were inspected: LPA Castellanos observed the indoor and outdoor arears of the home. LPA observed the home has a kitchen a wide/large living room space, a bathroom. No bedrooms were observed. The licensee states the main care will be provided in the living room. LPA observed in the living room area, a small couch, age-appropriate toys, bookshelf, cubbies, cots, children tables, small children’s chairs, and a piano. LPA observed the bathroom to be clean and hazardous chemicals locked away and inaccessible to the children and cabinet with safety locks. Kitchen there is a sink, countertop stove, refrigerator, cabinets with safety locks. Closet space LPA observed two air mattresses. All areas of the home are accessible to the children in care The outdoor area provided adequate shade, padding, and age-appropriate equipment. LPA did not observe a swimming pool or bodies of water on the premises. LPA Castellanos observed a working smoke detector, carbon monoxide detector, charged 2A10BC fire extinguisher and a first aid kit. The parent board was observed and required documents are currently posted by the entrance door. Licensee has current CPR, first aid, Lead Poisoning Prevention (LPP) Training.

Victor Bautista	TELEPHONE:
Lourdes Castellanos	TELEPHONE:
	DATE: 02/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021

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: VARDANYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494748
	VISIT DATE: 02/23/2021

NARRATIVE

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The following was discussed with the licensee/applicant
• 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 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.
• 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.

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE:
LICENSING EVALUATOR NAME: Lourdes Castellanos	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

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: VARDANYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494748
	VISIT DATE: 02/23/2021

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• 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

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

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.

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

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE:
LICENSING EVALUATOR NAME: Lourdes Castellanos	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

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: VARDANYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494748
	VISIT DATE: 02/23/2021

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SIDS & SHAKEN BABY SYNDROME INFORMATION discussed.
Safe Sleep Practices were discussed with the applicant. When putting infants to sleep, children must be placed on their backs, in a crib, on a firm mattress with nothing in the crib except for a fitted sheet over the mattress. The child should be physically monitored every 15 minutes along with their temperatures, color of skin, and breathing. LPA provided PIN 20-24 CCP to applicant.

LPA discussed with licensee the process of childcare during a pandemic. LPA discussed with applicant facial coverings in day care, social distancing, hand washing hygiene, postings, and cleaning and disinfecting of surfaces and high traffic areas. LPA advised children should follow social distancing when indoors. LPA discussed isolation area with applicant when children are sick until parents arrive. LPA discussed the importance and process of health screenings for children upon arrival to the facility. LPA provided CCP Self-Assessment Guide and Technical Assistance.

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

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 Property Owner/Landlord Consent Form•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.mandatedreporterca.com – must be renewed every two (2) years

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: Victor Bautista	TELEPHONE:
LICENSING EVALUATOR NAME: Lourdes Castellanos	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

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: VARDANYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494748
	VISIT DATE: 02/23/2021

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A copy of the LIC809 Facility Report was provided to Applicant, Gohar Vardanyan, via email. Applicant replied to email to acknowledge receipt of report. The Applicant agrees to reply to the email stating the report was received and read in lieu of a signature as required by tele-inspection protocols. The licensing determination of this application will be reviewed with the Licensing Program Manager for final resolution.

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE:
LICENSING EVALUATOR NAME: Lourdes Castellanos	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

LIC809 (FAS) - (06/04)

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