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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700035
Report Date: 03/02/2023
Date Signed: 03/02/2023 12:21:41 PM

Document Has Been Signed on 03/02/2023 12:21 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:SARGSYAN FAMILY CHILDCAREFACILITY NUMBER:
195700035
ADMINISTRATOR:ELZA SARGSYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 205-3929
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/02/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:ELZA SARGYSAN, APPLICANTTIME COMPLETED:
12:30 PM
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On 03/02/2023 at 9:45am Licensing Program Analyst (LPA) Lisa Clayton met with applicant for an ANNOUNCED PRE-LICENSING INSPECTION. LPA Clayton met applicant Elsa Sargsyan. There were no children in care. The home was toured with the applicant for a health and safety inspection. Hours of operation are Monday through Friday, 6:00am to 8:00pm. Applicant will provide breakfast, lunch and am/pm snacks.

This is a single-family home which consists of the following: 3 bedrooms, 2 1/2 bathrooms, living room, kitchen, detached shed and detached garage, in a fenced front and back yard. The home is neat and clean with heating and ventilation for safety and comfort. The applicant has requested the OFF-LIMIT AREAS are as follows: bedrooms 1, 2 and 3, bathroom #1, kitchen, detached garage and shed all of which will be inaccessible by child safety gates, closed and/or locked doors and visual supervision.

The Applicant has requested the following rooms be ON-LIMITS: bathroom #2, bathroom #3, living room (day care room) and the backyard. The ISOLATION AREA will be in the living room and the children will nap in the day care room on cots.

Per applicant, there are no firearms in the home. A copy of the mortgage was reviewed and shows control of property.

The home has a fully charged 2A:10: BC Fire Extinguisher and 2 working smoke detector/ carbon monoxide detectors combo and working telephone. Applicant CPR/First Aid certificate is current and expires October 2024. The applicant is in compliance with the immunization law which pertains to day care providers.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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: SARGSYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700035
VISIT DATE: 03/02/2023
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LPA Clayton informed applicant of the following:

o There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
o Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
o Saucer chairs, bouncers, walkers, or any similar items are prohibited.
o All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
o LPA provided and advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov


Based on today's inspection the following corrections are required prior to issuing a license:
· gate area on the side of the shed
· gate the east side of the home
· cover rain sump pump opening
· gate/section off the driveway
· access to the garage for inspection
· child safety gate for the kitchen

Proof of corrections are to be reviewed at the follow-up Pre-Licensing inspection on March 16, 2023.

An exit interview was conducted, and a copy of this report was provided to applicant. A notice of site visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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