195700035-3-9-2023-58-CC-LCLN-CPRRCL-20230309115430

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195700035
Report Date: 03/09/2023
Date Signed: 03/09/2023 11:55:54 AM

Document Has Been Signed on 03/09/2023 11:55 AM - 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 CHILDCARE		FACILITY NUMBER:	195700035
ADMINISTRATOR:	ELZA SARGSYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 205-3929
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	03/09/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	ELZA SARGSYAN, LICENSEE		TIME COMPLETED:	12:00 PM

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On 03/09/2023, Licensing Program Analyst (LPA) Lisa Clayton arrived at the FCC to conduct an announced Pre-Licensing – Correction inspections, a follow up on the Pre-Licensing visit conducted on 03/02/2023.

LPA discussed the safe sleep regulations with applicant 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.

Safe Sleep Practices were discussed with the applicant. When putting infants down to nap or long periods of sleep, children must be placed on their backs, in a crib, on a firm mattress with nothing in the crib except for a fitted sheet over the mattress. The child must be physically monitored and documented every 15 minutes, check their temperature, color of skin, and breath.

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.

California Law requires Family Child Care Home applicants to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

The Applicant was informed of the Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the applicants and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541

Email: childcareadvocatesprogram@dss.ca.gov

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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: 03/09/2023

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Update on Incidental Medical Services (IMS):
Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department.
IMS Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag. Incidental Medical Services (IMS) policy was discussed. For further 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

LPA discussed with applicant the process of childcare during a pandemic: facial coverings in day care, social distancing, hand washing hygiene, postings, and cleaning and disinfecting of surfaces and high traffic areas. Children should follow social distancing when indoors. LPA Clayton discussed isolation area with applicant when children are sick. LPA discussed the importance and process of health screenings for children upon arrival to the facility. LPA also provided resources and materials as well as links for COVID-19 to assist the provider. LPA also discussed the proper way to clean and disinfect items used daily throughout the day care, by submerging toys in or spraying with disinfectant and allowing enough contact time prior to wiping down.

LPA discussed with applicant the process of childcare during a pandemic: facial coverings in day care, social distancing, hand washing hygiene, postings, and cleaning and disinfecting of surfaces and high traffic areas. Children should follow social distancing when indoors. LPA Clayton discussed isolation area with applicant when children are sick. LPA discussed the importance and process of health screenings for children upon arrival to the facility. LPA also discussed the proper way to clean and disinfect items used daily throughout the day care, by submerging toys in or spraying with disinfectant and allowing enough contact time prior to wiping down.

A complete packet of the documents listed below, as well as a ratio flyer, Effects of Lead exposure, PIN 19-02 on Safe Sleep, PIN 19-18 Emergency Disaster, Never Shake a Baby flyer, was provided and discussed with the applicant during this inspection.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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: 03/09/2023

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CHILDREN'S RECORDS REQUIREMENTS:

· LIC 700 Identification and Emergency Information

· LIC 627 Consent for Emergency Medical Treatment
· LIC 282 Affidavit Regarding Liability Insurance
· LIC 9150 Parent Notification Additional Children in Care
· LIC 9927 Individual Infant Sleeping Plan
· LIC 995A Notification of Parent’s Rights
· LIC 613A Personal Rights
· Immunization Record

FACILITY RECORDS:
· LIC 624B Unusual Incident/Injury Report
· LIC 9040 Child Care Facility Roster
· LIC 9052 Employee Rights,
· LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
· LIC 9149 Property Owner/Landlord Consent Form
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates
· Copy of your deed or lease/rental agreement
· Documentation of Fire and Disaster drills
· Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandatedreporterca.com – must be renewed every two (2) years

FORMS TO BE POSTED

· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster

The applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Please report Telephone number changes and/or if you move from home.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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: 03/09/2023

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The corrections that were 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

LPA observed:
· gated area on the side of the shed
· child safety gate on the east side of the home, making it inaccessible to children in care
· covered rain sump pump opening (licensee adult daughter stood on the cover, LPA Clayton observed no gaps between the cover and the opening
· driveway sectioned off from the backyard using a child safety gate, making the driveway inaccessible to children in care
· LPA Clayton inspected the inside of the detached garage, which will be inaccessible to children with a locked door at all times
· child safety gate making the kitchen inaccessible

This home is recommended for licensing on 03/09/ 2023.

An exit interview was conducted, and a copy of this report was provided to Licensee. 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: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

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