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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700018
Report Date: 03/08/2023
Date Signed: 03/08/2023 05:00:59 PM

Document Has Been Signed on 03/08/2023 05:00 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: 2DATE:
03/08/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:GAYANE ZAKARYAN - LicenseeTIME COMPLETED:
05:15 PM
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On 3/8/2023 at 1:42pm, Licensing Program Analyst (LPA) Suzette Ornelas and Licensing Program Analyst (LPA) Maria Rendon arrived to the Zakaryan Family Child Care Home for a capacity increase inspection for a large family child care. LPA's met with licensee Gayane Zakaryan and assistant Rubik Yeghiazaryan who will serve 14 children ages 0-13 years old, Sunday through Saturday 6am-5:59am. Fire Clearance STD 850 was GRANTED on 2/3/2023. LPA's completed a tour of the home inside and outside.

Upon conducting the facility walk through, LPA's observed an infant asleep in bedroom 1 in a Pack n Play with loose article (blanket) over his body with his face fully visible. LPA's reminded licensee of the infant safe sleep regulations and ensuring there is nothing inside of the crib when infants are sleeping. Licensee immediately removed blanket from over child's body and stated blanket was over childs body per mothers request. LPA's reminded licensee that as a provider, she is to follow regulations and will be provided with information to share with parents regarding infant safe sleep today.

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. There is an additional room behind the garage as well as a restroom. 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 right 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.
Master bedroom, bedroom 1 and 2, bathroom located in the hallway, dining room/living room area, den, activity room (city permit approval provided) behind garage are on limits and accessible to children in care. Kitchen is off limits to children in care by the use of closed doors, safety gates and supervision. The facility is spacious enough to fit 14 children.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ZAKARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700018
VISIT DATE: 03/08/2023
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A capacity regulations flyer was given licensee to show how many children and their ages can be cared for at once. LPA's provided licensee with information on infant safe sleep regulations along with safe sleep environment flyers, safe sleep log, safe sleep regulation and frequently asked questions. LPA's also provided licensee with LIC311D -forms/records to keep at your family child care home and the Family Child Care Home Entrance Checklist, to ensure files are maintained up to date. LPA's reminded licensee to ensure the fire extinguisher is serviced yearly and has either purchase receipt or service tag readily available.

Proof of corrections have been discussed with Applicant, including:
  • Obtain a total of 3 cribs with fitted mattresses and 2 additional cots for a total of 12. You currently have 6 cots and 1 crib.
  • Before using the backyard activity space, plants with thorns need to be made inaccessible to children in care.
  • Children's table
Final license determination will be made upon review by the Licensing Program Manager and correction of the above issues. Applicant to correct items by 3/24/2023.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: Type A- 102425(b) Infant Safe Sleep (see next page, 809 D) Licensee was provided a copy of their appeal rights. Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.
LPA's informed licensee that this report dated 3/8/2023 documents 1 Type A citation 102425(b) which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care. Exit Interview Conducted.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
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Document Has Been Signed on 03/08/2023 05:00 PM - It Cannot Be Edited


Created By: Suzette Ornelas On 03/08/2023 at 03:47 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ZAKARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700018

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/08/2023
Section Cited
CCR
102425(b)

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102425(b) Infant Safe Sleep (b) Cribs or play yards shall be free from all loose articles and objects.

This Requirement is not met as evidenced by:
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LPA's observed Licensee remove loose object from inside pack-n-play during visit. Licensee stated she will review all provided safe sleep information and provide informtion to parents. Licensee will also provide a declaration of understanding to LPA on or before the close of business on 3/24/2023.
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Based on LPA's observations, interview with Licensee, 1 infant were observed in 1 pack-n-play with a blanket which poses a potential health, safety or personal rights risk to person in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2023


LIC809 (FAS) - (06/04)
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