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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700488
Report Date: 04/27/2021
Date Signed: 04/27/2021 11:59:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LALAYAN FAMILY CHILD CAREFACILITY NUMBER:
197700488
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
04/27/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:21 AM
MET WITH:Applicant Silva LalayanTIME COMPLETED:
12:00 PM
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On April 27, 2021, Licensing Program Analyst (LPA) Brigitte Tsutaoka met with Applicant, Silva Lalayan, who guided analyst on a tour of the facility for a small family child care home Change of Location Pre-licensing tele-inspection. As a COVID-19 safety precaution, the inspection was conducted remotely using FaceTime. This is a two story 3 bedroom, 2 bathroom home with kitchen/dining, day care room, living room, and garage. There is no pool/spa or body of water on the premises. Family members residing in the home include 2 adults (applicant, applicant's spouse) and 3 children. Incidental Medical Services (IMS) policy was discussed.

Main care is provided in day care room (next to dining room). Children use the bathroom in hallway next to the kitchen. Off limits areas include the entire upstairs (Bedroom #1 through #3, bathroom #2), kitchen, and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (garage), medicines (master bedroom) and hazardous items (sharp knives in upper kitchen cabinet in plastic container) that can pose a danger to children. Applicant reminded to conduct fire/earthquake drills every 6 months and document. A Roster was provided to Applicant to complete and maintain. Stairs have a gate.

The backyard is completely fenced. There are no animals on the premises. Facility has fake grass which is completely fenced. Backyard is clean and free from hazards
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021
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 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LALAYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700488
VISIT DATE: 04/27/2021
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Per Applicant, there are no weapons or firearms on the premises. LPA did not observe any in the home at this time. There are age appropriate toys. According to Applicant, there is age appropriate napping equipment (cots) which are currently being used at the other facility. LPA did not observe them at this time. Applicant agreed to send picture of cots. The required fire extinguisher (2A10BC), Carbon Monoxide detector, and smoke detector are in operable condition. Fireplace is screened. Home has central AC and heat. CPR/First Aid expire 09/14/2021. Preventive Health and Safety completed 09/16/2017. Lead Poisoning Prevention completed 04/07/2021. The First Aid kit was observed and is complete. Applicant agreed to send pictures of no-touch thermometer.

The following was discussed with the Applicant:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Applicant reminded that 100% supervision is required at all times to children in care. Applicant was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov . Applicant was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Applicant was advised that inaccessibility of hazards must be constantly reassessed depending on the children in 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 tobacco in a private residence that is licensed as a family child care home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

--Applicant is advised visit www.shotsforschool.org for Immunization information.
--Applicant was informed of responsibility to report suspected Child Abuse, 1-800-827-8724/760-243-6640
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LALAYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700488
VISIT DATE: 04/27/2021
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--Family Child Care Providers (Disaster Planning information): https://ccld.family-child-care-providers/disaster-planning-and-fire-safety/
--Child Care Videos: https://ccld.childcarevideos.org
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Applicant advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
--Provider Information Notice (PIN) Summary - PIN 18-02-CCP; Family Child Care Providers (Disaster Planning information):https://cccld.childcarevideos.org/family-child-care-providers/disaster-planning-and-fire-safety/

Applicant was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624. Pamphlet Information regarding SIDS, items that are not permitted in a licensed facility and Notification of Parent's Rights poster (Palmdale Regional Child Care Office) were provided. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

Incidental Medical Services (IMS) 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, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021
LIC809 (FAS) - (06/04)
Page: 3 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LALAYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700488
VISIT DATE: 04/27/2021
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Requirements for fingerprint clearances and associations were discussed with the Applicant. The applicant was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately.

Applicant informed to review Quarterly updates/regulations for 2015-2021 on the department website which includes information on: AB 1207 - all child care employees must complete mandated reporter training beginning January 1, 2018 and complete by March 30, 2018; AB 1387 - and AB 2236 process to request a formal review of deficiency and establishes an appeal process for civil penalties; SB 277 - require all children attending day care or school based programs to be immunized and will eliminate personal/religious belief exemptions; Summer 2015 - Incidental Medical Services information.

Applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).

The On Duty Worker is available for questions at 661-202-3318 Monday through Friday 8am-5pm. LPA provided consultation during the inspection.

During inspection, COVID-19 technical assistance was provided.

Before licensure the following must be completed:


1. Update Facility Sketch (LIC999A) with Off-Limits areas.
2. Send LPA picture of cots and no-touch thermometer.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LALAYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700488
VISIT DATE: 04/27/2021
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Once corrections have been verified, the application for a small Family Child Care Home will be submitted for approval with a maximum capacity of 6 or 8 with parent notification. Applicant advised that all corrections are due within 30 days or the application may be withdrawn.

An exit interview was conducted, and a copy of this report was read and emailed with read receipt (due to COVID-19) to the Applicant in lieu of signature on this date.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5