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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700018
Report Date: 12/13/2022
Date Signed: 12/13/2022 01:09:59 PM

Document Has Been Signed on 12/13/2022 01:09 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ZAKARYAN FAMILY CHILD CAREFACILITY NUMBER:
195700018
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:GAYANE ZAKARYANTIME COMPLETED:
01:25 PM
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On 12/13/2022 Licensing Program Analysts (LPA) Laticia Thompson conducted an announced Pre-Licensing inspection at the facility to ensure that health, safety and personal rights as required by Title 22 Regulations governing California Family Child Care homes will be met by the applicant. This is an application for a Small Family Child Care Home for 8 children ages Infant to 13 years of age. The family child care home will operate from 6AM. to 5:59 AM, SUNDAY thru SATURDAY. Upon arrival, LPA met with applicant Gayane Zakaryan and was guided on a tour of the indoor and outdoor of the home

Per facility sketch and tour of the home, the following was observed and discussed with the applicant during the inspection:
Home is a 1 story dwelling. The family child care home consists of 3 bedrooms, one living room, one dining room, a den 2 bathrooms and a detached car garage. The driveway is located on the right side of the front door and leads to the garage and backyard. Parents will enter and exit through a pathway on the left side of the home leading to the backyard. In the backyard there is a stair casing that leads to a sliding door where children will enter and exit into the back of the home, the stair casing has a mesh gate at the bottom and a bar gate at the top.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ZAKARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700018
VISIT DATE: 12/13/2022
NARRATIVE
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  • The Dinning Room located at the front entrance of the home has a fireplace. There is a glass barricade preventing access to the fireplace.
  • The Master bedroom and bathroom (off limits) are located to the left of the dinning room and front door. This area is inaccessible to children and has a safety door latch preventing access.
  • Bathroom #2 located in the hall area next to the master bedroom will be used for children in care
  • The Bedroom next to the bathroom (off limits) is inaccessible to children and has a safety door latch preventing access
  • Kitchen area has safety latches on refrigerator door and bottom of kitchen sink making these areas inaccessible to children in care. Applicant will place safety latches on drawers and cabinets that contain sharp knives, medications, and alcoholic beverages.
  • There are steps located next to the kitchen that leads to the day care room. The area has a mesh safety gate preventing access from day care room area to front area of the home. These steps will be used by children in care to access the bathroom.
  • Day Care room is where primary care will be provided. LPA observed safe toys, learning material, and play equipment. The children will play, eat and nap in the day care area. There are 6 cots and 1 play yard. There is a board with all prominent documents posted.
  • The bedroom located next to the day care area will be used when children are feeling ill and also for care.


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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ZAKARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700018
VISIT DATE: 12/13/2022
NARRATIVE
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  • Large closet with doors located next to the bedroom which contains a washing and dryer. Applicant will place a safety latch on doors to prevent access. LPA observed bleach and laundry detergent on shelves.
  • There is a sliding glass door in the day care area that leads to the backyard. The sliding glass door has a lock on the handle and an alarm alerting when door opens.
  • The backyard area will be used as a play area. There is no play equipment in the backyard play area at this time. Applicant will notify department when cushioning and play equipment is purchased. There is a barbecue area with cabinets and openings. Applicant will ensure that children will be supervised at all times and will not access this area. Applicant will place a gate to prevent access to this area.
  • Bathroom located in backyard area attached and behind the garage is off limits.
  • Room located in the backyard behind the garage will be used as an activity area. Children in care will not eat or sleep in this area. Applicant will remove all hazardous material from cabinets located in the room.
  • Garage (off limits) has a security code panel to gain access

The following was also observed by LPAs during the inspection
All adults living in the home have submitted fingerprints and child abuse index check forms to Department of Justice.
Home is neat and clean.
Home is equipped with a fully charged 2A:10BC fire extinguisher with an inspection tag dated 09/06/2022 located in the day care area.

Home is equipped with an operable smoke alarm and a carbon monoxide detector located in the day care area Page 3

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ZAKARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700018
VISIT DATE: 12/13/2022
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Home has a working landline telephone( 747) 228-1103 and cell phone will be used a primary contact.

Some poisons detergents, cleaning compounds are inaccessible to children and are located under the kitchen sink with a safety latch preventing access.

Hazardous materials are kept out of the reach of children (inaccessible):

According to the applicant, there are no weapons or firearms in the home. None were observed by the LPA.

Outdoor play area is fenced in.

LPA observed a fire pit completely covered, enclosed with a secure black covering
No bodies of water were observed during the inspection.
The home is equipped with a first-aid kit equipped with, cleansing pads healing ointment, bandages, gauze, and a digital thermometer, scissors and tweezers located in the kitchen cabinet.
Applicant husband smokes, Applicant ensures that husband will not smoke in the home or while children are in care. 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
Mandatory Forms for the children’s files were provided to applicant. Licensee was referred to LIC 311D: Records To Be Maintained At The Facility - Family Child Care Home

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ZAKARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700018
VISIT DATE: 12/13/2022
NARRATIVE
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Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

Proof of corrections have been discussed with applicant, including:

· Applicant will place safety latches on laundry room closet area, kitchen cabinets containing medication, sharp items, and alcoholic beverages.


· Remove gym equipment from backyard play area
· Place a safety gate preventing children from accessing barbecue cooking area with cabinets
· Remove all hazardous material from cabinets located in activity room behind garage
· Provide pictures of play equipment and cushioning in back yard when purchased.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with [applicant, licensee, or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ZAKARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700018
VISIT DATE: 12/13/2022
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LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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


LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ZAKARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700018
VISIT DATE: 12/13/2022
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An exit interview was conducted with the above items discussed and a copy of this report was provided to the applicant. Final license determination will be made upon review by the Licensing Program Manager and correction of the above issues . Applicant to correct items by 12/23/2022

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7