195700071-5-9-2023-58-CC-SGAN-CRNQFJ-20230509120803

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195700071
Report Date: 05/09/2023
Date Signed: 05/09/2023 12:08:17 PM

Document Has Been Signed on 05/09/2023 12:08 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:	STEPANYAN FAMILY CHILD CARE		FACILITY NUMBER:	195700071
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	05/09/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Ani Stepanyan, Applicant		TIME COMPLETED:	12:10 PM

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On 5/09/2023 Licensing Program Analyst (LPA) Silva Garibyan conducted an announced inspection with applicant Ani Stepanyan for the purpose of a pre licensing inspection of 2939 N. Buena Vista Street, CA 91504 (The zip code that was input is incorrect. The correct zip code is 91504). The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

The licensee is applying for a Small Family Child Care Home license for a maximum capacity of 8 children. Per the application, at this time, the ages the applicant wishes to provide services for are children newborns through 14 years old with the hours of Monday- Friday from 7:00 a.m. to 11:00 p.m. Licensee was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes. Landlord Consent and copy of current rental agreement is on file. Applicant has no pets. Applicants' home is a single story, 3 bedroom, 2 bathroom home with living/dining room, covered patio/play room, kitchen, and converted garage. Parents will access the home through the side gate and the door leading to the patio/play room. Three bedrooms, one of the bathroom in the licensee's bedroom, the kitchen, and the garage are off limits to the children in care. Children will eat and sleep in the living/dining room. The children will have access to the bathroom located in the hall way near the bedrooms. Family members residing in the home include three adults ( applicant, spouse, and mother-in-law) and applicant's two children ( 6 years old and 3 years old). Applicant was informed that her children under 10 years of age, count in her capacity whenever they are present. LPA observed a parent board in the patio/play room. Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , Child Care Facility Roster (LIC9040), Emergency Disaster Plan (LIC610a), Lead Poisoning Facts/Potential Sources Of Lead/Effects Of Lead Exposure. A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card. Page 1

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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: STEPANYAN FAMILY CHILD CARE	FACILITY NUMBER: 195700071
	VISIT DATE: 05/09/2023

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The living/dining room was observed to have children size table and chairs and a variety of age appropriate materials. LPA observed children’s books, blocks and wooden play kitchen. LPA observed napping cots, and emergency water and first aid kit. LPA observed applicant test the carbon monoxide and smoke detector in the space. LPA observed a fire extinguisher mounted in the play room. All electrical outlets in the home were covered.
Bedrooms were observed and inspected. Applicant has designated the bedrooms as OFF LIMIT to the children in care. LPA observed a plastic doorknob covers making the bedrooms inaccessible.

The bathroom that children will use is in the hall way near bedrooms. A toilet, sink and shower were observed. The cabinet under the sink was observed to be free of hazards. LPA discussed COVID-19 recommendation such as using paper towels and displaying a hand-washing sign for children to view.

The kitchen area was observed to have a safety gate between the living/dining room and kitchen, locked door between hall way and kitchen. LPA observed, all bottom cabinets were observed to have safety latch. Stove was observed to have children’s safety latches making them inaccessible to the children in care.

Home will access the backyard through the patio/play room door. Backyard is enclosed with a fence. The area in which the garage is located is fenced off from the remainder of the play area. The play area is also fenced off from the remainder of the yard. The yard was observed to have age appropriate toys and yard was covered with outdoor carpet. No bodies of water were observed in the home. Applicant confirmed NO fire arms or weapons are in the home.

Facility Administration: Licensee completed training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. Pediatric A certificate of completion of a course or courses in preventive health practices as defined in s subdivision (a) or certified copies of transcripts that identify the number of hours and the specific course or courses taken for training. (8 hours required) Preventative Health and Safety practices including childhood nutrition/Lead Exposure Prevention are completed and placed in facility file.

Licensee 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. Page 2

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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: STEPANYAN FAMILY CHILD CARE	FACILITY NUMBER: 195700071
	VISIT DATE: 05/09/2023

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Applicant was made aware 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 in order 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 licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.

Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation. Applicant was also informed that the provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.

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. LPA also informed licensee 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.

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. Page 3

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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: STEPANYAN FAMILY CHILD CARE	FACILITY NUMBER: 195700071
	VISIT DATE: 05/09/2023

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APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:

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.

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 license 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.

Applicant was informed that the following is pending licensure and needs to be corrected within 30 days from the date of this report

1) A copy of the renewed Mandated Reporter Training certificate ( expired 04/26/2023)

Exit interview was conducted with licensee Ani Stepanyan. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

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