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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700292
Report Date: 08/03/2021
Date Signed: 08/03/2021 11:44:42 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 CAREFACILITY NUMBER:
197700292
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
08/03/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:GOHAR KHACHATRYANTIME COMPLETED:
11:55 AM
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On August 3, 2021 at 9:30AM, Licensing Program Analyst (LPA) Loyce Phillips conducted a Case Management-Other Visit. LPA met with Licensee Gohar Khachatryan for the purpose of a capacity increase inspection for a large family childcare. The facility was granted a fire clearance on 7/20/2021. Days and hours of operation are Monday through Friday, 8:00 AM to 6:00 PM.

LPA toured the home inside and outside and a census was taken. During today's inspection 5 children were present with Licensee, assistant, Licensee's spouse and minor son. This is a single story family home which consists of a kitchen, dining room, living room, family room, 3 bedrooms, 2 bathrooms, and an attached garage. The primary care for children will be conducted in the family room (playroom), living room and bedroom #3 (napping room). Children will have access to bathroom #2 locate to the right of the hallway. The backyard is completely enclosed with a fence. The backyard has artificial grass with toys, bikes, a play house and a small slide set for active play. The children will only have access to the lower area of the backyard.



The off-limit areas of the home includes the attached garage, bedroom #1, bedroom #2 and bathroom #1. Bedrooms #1 and #2 and attached garage are made inaccessible to children by safety door knobs. The living room has a fire place which is inaccessible to children by a safety gate.

There is no swimming pool or other bodies of water on premises. There are no firearms or ammunition on the premises. All poisons are kept in under the kitchen sink with a child's safety lock. No poisons were observed during the inspection.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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: 197700292
VISIT DATE: 08/03/2021
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The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation. Medications are stored in bedroom #1 inaccessible to children. Detergents and cleaning compounds are stored in the garage inaccessible to children. The kitchen knives are stored in kitchen drawer inaccessible to children by safety latches

The First Aid kit is located in the bathroom #2 inaccessible to children. The home has working Smoke and Carbon Monoxide detectors. The Fire Extinguisher is operable. The Licensee's Pediatric CPR/First Aid expires on 6/17/2023 and required Mandated Reporter training completed on 6/17/2021.

The required posted documents were posted and located in the childcare room: Notification of Parent's Rights Poster (PUB394), Emergency Disaster Plan (LIC610A), Earthquake Preparedness Checklist (LIC9148) and License.

The following was discussed with Licensee:
Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills every month and record it; Role and responsibilities of being a mandated reporter were reviewed; The licensee was reminded that 100% supervision is required at all times to children in care; Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

Licensee was informed that all adults living in or having access to the home, or employees are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Central Index prior to having contact or working with children. If the is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analysis of any person who will be visiting regularly or for longer than one week. Licensee was advised to utilize the Request for Live scan Service LIC9163 to have adults fingerprinted and associated to the home.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700292
VISIT DATE: 08/03/2021
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Licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. Licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) 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. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700292
VISIT DATE: 08/03/2021
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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.

Licensee stated there is currently 1 infants in care. LPA discussed Safe Sleep Regulations with licensee. Which includes each infant in care should have their own crib or play yard. The cribs and play yards should be kept free from all loose articles and objects while infants are sleeping; and there should be no objects hanging above or attached to the crib or play yard. Infants should not be swaddle while in care. Licensee will physically check on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants should be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and placed in the file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

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 is in the front yard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

Licensee was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov

The home is ready for licensure for a large family child care, pending managers approval.

An exit interview was conducted, a copy of this report was read and provided to the Licensee, Gohar Khachatryan.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4