195700109-7-21-2023-58-CC-MREN-CTXS7J-20230721133738

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195700109
Report Date: 07/21/2023
Date Signed: 07/21/2023 01:37:49 PM

Document Has Been Signed on 07/21/2023 01:37 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:	SEVINYAN FAMILY CHILD CARE		FACILITY NUMBER:	195700109
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	07/21/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Naira Sevinyan		TIME COMPLETED:	01:53 PM

NARRATIVE

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On 07/21/23, at 8:35 am, Licensing Program Analyst (LPA) Maria Rendon met with Applicant Naira Sevinyan. The purpose of the visit was an announce pre-licensing inspection at the facility located at 17521 Kittridge Street, Lake Balboa, CA 91406 to ensure that health, safety, and personal rights as requires by Title 22 and Health and Safety Regulations governing California Child Care Homes will be met. This is an application for a Large Family Child Care Home. Applicant is requesting a capacity of 14 children, ages 0 years to 13 years old. The Family Child Care Home will operate Monday – Sunday 6:00 a.m. – 11:00 p.m.

The applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Beginning at 8:40 am, applicant guided LPA on a tour of the residence and back yard. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one-story Additional Dwelling Unit that is located on the property of 17523 Kittridge Street. LPA reviewed the Certificate of Occupancy that applicant had on file. The home where the applicant lives consists of an open floor plan living room and kitchen area, 1 bathroom and 1 bedroom. All areas identified on the facility sketch are accessible to children which includes living room, kitchen, bedroom, and bathroom.

LPA Rendon observed a working combo carbon monoxide and smoke detector in the home and LPA Rendon was able to hear a successful test. A total of 1 smoke detectors were observed and are located in the bedroom. Fire extinguisher 3-A:40-B:C located on the wall in the living room was purchased on 7/05/2023. Electrical outlets were observed to be inaccessible to children in care with the use of plug covers. The home was observed to be clean and orderly with heating and ventilation. LPA observed safe toys, play equipment, and materials. LPA Rendon verified the home has a working telephone service.

LPA advised, baby walkers, bouncer, Johnny jumper, trampoline, saucer chairs are not permitted.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

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: SEVINYAN FAMILY CHILD CARE	FACILITY NUMBER: 195700109
	VISIT DATE: 07/21/2023

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The mesh gate makes the pool that is on the property inaccessible to the children in care. The front yard was observed to be part of the driveway and applicant states that no cars park in the driveway. On the left side of the backyard, LPA observed a solid white plastic gate with a door that has a pad lock to make the pool area inaccessible. On the right side of the back yard, LPA observed a second door that leads to the side of the home. LPA observed a combination padlock which makes the side of the house inaccessible to children. LPAs advised, outdoor play areas shall be supervised by the licensee.

When a child is ill, he/she will be separated from the other children. Isolation area will be located in the living room area on the sofa. Home was observed with an emergency kit backpack which contains first aid kit and other essential items that are needed in case of an emergency. The emergency kit is located in the living room area.

LPA reviewed staffing ratio and capacity with applicant. LPA advised per CC Regulation 102416.5(e) Staffing Ratio and Capacity (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

Smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

LPA advised that baby walkers, bouncer, johnny jumper, saucer chairs are not permitted.

LPA advised that fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Safety Commission shall not be used for children in care or accessible to children in care.

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. Entrance Checklist was provided to the applicant.

LPA provided applicant with the following required postings: LIC610A Emergency Disaster Plan, PUB 394 Notification of Parents’ Rights Poster, and LIC 9148 Earthquake Preparedness Checklist. LPA advised that once licensed, the facility license shall be posted. LPA advised that all LIC9213 Notice of Site Visits shall be

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: SEVINYAN FAMILY CHILD CARE	FACILITY NUMBER: 195700109
	VISIT DATE: 07/21/2023

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LPA observed cleaning compounds and detergents inaccessible to children under the kitchen sink and are made inaccessible by a child proof latch. LPA advised poisons shall be locked with a key or a combination lock.

LPA observed the home to have 4 cots and 1 play yard located in the bedroom for napping. LPA advised, there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. LPA advised, the placement of cribs or play yards shall not hinder entrance or exit to and from the space where infants are sleeping. LPA advised, mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. Mattresses shall be made specifically for the size crib or play yard in which they are placed. LPA advised, cribs or play yards shall be free from all loose articles, objects, bumper pads shall not be used, and there shall be no objects hanging above or attached to the side of the crib.

LPA observed 1 toddler table and several small chairs. Applicant stated that the tables will be used for eating and table activities. LPA also observed a dining table and applicant states that older children will use the table for activities and eating. LPA observed 2 highchairs for infants to use while eating.

Per applicant, there are no firearms located in the home.

Kitchen was observed with sharp utensils and knives rendered inaccessible. LPA observed medication in the refrigerator and it is inaccessible to children with the use of a U shape safety latch on the handles of the refrigerator doors. Kitchen was observed to be clean. The applicant states that she will provide food for children in care. If food is brought from the children’s homes; container(s) shall be labeled with child’s name and properly stored or refrigerated.

Bathroom was observed to be clean with toilet and faucet safe and operable. LPA observed shower to be free of hazards. LPA advised shampoos, mouthwash, soap, medication, perfumes, razor blades, air freshener, nail polish/ remover shall be inaccessible to children.

Outdoor area is in the front yard and in the back yard of the home. In the front yard, LPA observed a secured mesh gate in front of the applicant’s home that extends to the home that is located on the property.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: SEVINYAN FAMILY CHILD CARE	FACILITY NUMBER: 195700109
	VISIT DATE: 07/21/2023

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posted for 30 days after each site visit. LPA advised that any licensing report documenting a Type A citation must be posted for 30 days. LPA advised that a disaster drill log shall be posted with disaster drills completed at lease every six months.

LPA advised that the applicant shall reveal each child care center license number in all advertisements in accordance with Health and Safety Code Section 1596.861.

LPA advised that per FCCH regulation, Section 102417(a) Operation of A Family Child Care Home: The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

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.

On this date, 4/26/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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 Applicant Naira Sevinyan of the importance of checking for recalled

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: SEVINYAN FAMILY CHILD CARE	FACILITY NUMBER: 195700109
	VISIT DATE: 07/21/2023

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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

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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

The following corrections are needed before a licensure will be considered. Corrections are due by 8/21/23 :

· Parent Board

· Updated facility sketch (floor plan and yard)

· Updated LIC 610A (section 5 Utility Shut Off)

An exit interview was conducted with the above items discussed and a copy of this report was provided to the Applicant Naira Sevinyan. Final license determination will be made upon review by the Licensing Program Manager and correction of the above issues. pg 5 of 5

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC809 (FAS) - (06/04)

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