197494888-9-2-2021-30-CC-MSIN-C6GVZ9-20210902165224

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494888
Report Date: 09/02/2021
Date Signed: 09/02/2021 04:54:18 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:	PEPANYAN FAMILY CHILDCARE		FACILITY NUMBER:	197494888
ADMINISTRATOR:	ZHANNA PEPANYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 645-5444
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	14	CENSUS: 0	DATE:	09/02/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:54 PM
MET WITH:	Zhanna Pepanyan		TIME COMPLETED:	05:15 PM

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	Tele-Visit via Face-Time. The pre-licensing visit was conducted in Armenian. Licensee has been advised that an email shall be sent with the report attached, which has been reviewed during the Tele-Visit and a read receipt via email shall be considered an acknowledgement that they are in receipt of this form. This is an announced pre-licensing tele-visit conducted by Margarit Sislyan, Licensing Program Analysts (LPA) on 9/2/2021 at 03:00 PM with Applicants, Zhanna Pepanyan who guided analyst on a tele-tour at the facility. The applicant was previously licensed. This is one story single family home with 4 bedrooms and 3 bathrooms. Family members residing at the facility are: 2 adults and 3 children. The applicant stated that her husband is separated and does not live in this house. The applicant stated that his husband is visiting the house. The bedrooms are off limit. The home was inspected for safety, comfort, cleanliness, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Per facility sketch there is no pool or other bodies of water on the premises. During the tele-visit LPA did not observe pool or any other bodies of water on the premises. LPA observed the detached garage was converted to a living area. The licensee rented out the converted garage to a couple. LPA observed there was an attached room to the converted garage with separate entrance from the converted garage. Licensee stated that the room is being used as a storage. LPA observed there was a lot of staff in the room. Page 1 of 4

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit Sislyan	TELEPHONE: (424) 430-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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 4

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: PEPANYAN FAMILY CHILDCARE	FACILITY NUMBER: 197494888
	VISIT DATE: 09/02/2021

NARRATIVE

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There are age appropriate toys and equipment on the premises. Applicant has provided proof of Preventative Health and Safety. CPR expires on 06/01/2023.
The required smoke detectors and carbon monoxide detector are in operable condition

Applicant has submitted a disaster plan and demonstrated control of property at the above address by Grant Deed.

The following discussed: No smoking, no infant walkers, Johnny jumpers, exersaucers or any other item that falls into that category.

The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements. Fingerprint clearance, transfer process and capacity / ratios. Regulation 102416.3 was explained and discussed
with applicant.

Novel Corona virus (COVID-19) Los Angeles County Department of Public Health Guidance for Early Childhood Education Providers was discussed.
Additional information available at: www.publichealth.lacounty.gov

Applicant was informed that it is required by law to post the following in the facility:
● Emergency Disaster Plan (LIC 610A) - This must be posted in your home next to the telephone and
The Earthquake Preparedness Checklist (LIC 9148), must be attached to the LIC610A and available
to the public.
● Notification of Parents' Rights Poster (PUB 394) - This poster must be placed in an area of the home
where all parents can see it
● Facility License, (LIC 203)-Your Family Child Care Home License must be posted in an area of the
home where it can be easily seen.
● Notice of Site Visit (LIC 9213) must remain posted for 30 days (during the hours that children are in care) after each site visit by a licensing representative.● Any licensing report documenting a type “A” citation must be posted for 30 days during the hours that children are in care.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit Sislyan	TELEPHONE: (424) 430-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: PEPANYAN FAMILY CHILDCARE	FACILITY NUMBER: 197494888
	VISIT DATE: 09/02/2021

NARRATIVE

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● Any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Employee records must be maintained by the applicant and shall contain the following: LIC9052/Employee Rights, LIC 9108 Mandated Reporter Form, an employment contract or application containing the following information: Employees Full Name, Date of Birth, Driver's License Number, Date of Employment, Documentation of Health and Safety Training, Duties of the employee. Licensee is reminded that records for employees as well as children must be maintained for 3 years after separation for the FCCH.

LPA discussed the safe sleep for baby pamphlet. Each infant shall be constantly supervised
and under direct visual observation by an adult person at all times. Under no circumstances shall any infant be left unattended. In order to visually observed and supervise sleeping infants there should be no obstruction to the view of the infants, which could include transparency walls and/or half walls. LPA recommend that infants sleep safest in crib with no bumpers, pillows, blankets, or toys, and on their backs, and every sleep time counts to reduce the risk of SIDS and other sleep related causes of infant death.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is 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.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit Sislyan	TELEPHONE: (424) 430-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: PEPANYAN FAMILY CHILDCARE	FACILITY NUMBER: 197494888
	VISIT DATE: 09/02/2021

NARRATIVE

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The following needed before licensure:

· Large size china cabinet in the day care room should be mounted to the wall to prevent the china cabinet's fall during the earthquake.
· Child proof latches shall be installed on the doors of the kitchen and the bathroom cabinet doors to prevent day care children's access to poisons, detergents, cleaning compounds, medicines and other items which could pose a danger.
· The play equipment installed in the side yard of the house shall meet the Title 22 requirements: Playground equipment shall be securely anchored to the ground unless it is portable by design. The areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.
· The applicant's husband and 2 tenants shall get criminal record clearance through live scan.
· Criminal Record Statement (LIC 508) for applicant's husband and tenants
· Copy of TB Clearance for applicant's husband and tenants

The requirements due by 10/02/2021

Exit interview

Page 4 of 4

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit Sislyan	TELEPHONE: (424) 430-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4