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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700138
Report Date: 08/03/2023
Date Signed: 08/03/2023 12:01:59 PM

Document Has Been Signed on 08/03/2023 12:01 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:AVETISYAN FAMILY CHILDCAREFACILITY NUMBER:
195700138
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/03/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Ashot Avetisyan and Lilit Babayan, ApplicantTIME COMPLETED:
12:00 PM
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Pre-Licensing Visit Conducted In Armenian
Licensing Program Analyst (LPA) Silva Garibyan conducted a pre-licensing inspection on 08/03/2023 at 8:15AM. LPA met with Ashot Avetisyan and Lilit Babayan, Applicants who guided analyst on a tour of the facility. Home is located on a lot with a back house with address: 6114 Carpenter Ave, North Hollywood, CA 91606. The back house will not have access to the Applicants' home and yard area which is separated by a 5 feet 11 inch plastic fence. The applicants are requesting a small family child care home license with a capacity of 8. Per applicants, operation hours will be Monday to Sunday from 7:00 AM to 10:00 PM. Applicants state they will care for children newborn to 14 years of age. Entrance Checklist was provided to the applicants. Applicants stated that a cell phones with active service in the home will be the main contact numbers while children are in care.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story home that consists of 3 bedrooms, 1 bathrooms, dining room, living room, Sun room, laundry area, and kitchen.

Per applicants, the children will use the following areas: Living Room (1) and Dining Room (2) as a playroom located in the front of the house and Bathroom (6) in the hall way. Page 1 of 5

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2023
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: AVETISYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700138
VISIT DATE: 08/03/2023
NARRATIVE
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The kitchen and the laundry area will be used as a walkway to access the back yard. Kitchen cabinets were observed and inspected. The stove, refrigerator, sink and counter space area were observed and inspected. Knifes and sharp objects observed to be made inaccessible to the children in care. Applicants confirmed that facility will be providing meals and snacks. LPA discuss food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date.

Applicants has submitted a disaster plan. The applicants have completed preventive health and safety/Childhood Nutrition/ Lead Exposure Prevention and Mandated Reporter training (completed on 04/29/2023 and 04/30/2029). The applicants have current pediatric CPR/First Aid training completed on 04/25/2023. Because the applicants rent/lease the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicants confirm was provided to the property owner/landlord. The applicants obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Bedrooms were observed and inspected. Applicant has designated all bedrooms and the sun room as OFF LIMIT to the children in care. LPA observed bedroom and sun room doors to with safety knob/locks making off limit areas inaccessible. The bathroom that children will use is in the hall way. A toilet, a sink, and a bathtub was observed. The bathroom was observed to be free of hazards.

Applicants confirmed no fire arms or weapons are in the home. Applicants are stating that when children are having outside time she will ensure 100% supervision and never leave children unattended. Page 2 of 5

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

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

DATE: 08/03/2023
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: AVETISYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700138
VISIT DATE: 08/03/2023
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Living room (1) was observed to have children size tables and chairs and a variety of age appropriate materials. LPA observed napping cots, play pan, and emergency water and first aid kit in the living room. LPA observed applicants test the carbon monoxide and smoke detector in the hall way. LPA observed a fire extinguisher (2A10BC) mounted in in the kitchen. All electrical outlets in the home were covered. The fireplaces located in the living room was barricaded with a 2.5 ft book shelf.

Applicants 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.


APPLICANTS 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) or (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.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

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

DATE: 08/03/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: AVETISYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700138
VISIT DATE: 08/03/2023
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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 discussed the safe sleep regulations with applicants and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource.
LPA also informed applicants 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.
On 05/26/2023, 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.
Applicants were 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.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

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

DATE: 08/03/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: AVETISYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700138
VISIT DATE: 08/03/2023
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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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication


Applicants were informed that the following is pending licensure and needs to be corrected within 30 days from the date of this report
  • Rental/Lease agreement
  • Parent board with posting requirements according to Title 22 Regulations.


Exit interview conducted and report was reviewed with the applicants, Lilit Babayan and Ashot Avetisyan.

Page 5 of 5
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

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

DATE: 08/03/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5