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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700159
Report Date: 12/05/2024
Date Signed: 12/05/2024 03:58:11 PM

Document Has Been Signed on 12/05/2024 03:58 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:KHACHATRYAN FAMILY CHILD CAREFACILITY NUMBER:
195700159
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
12/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Haykush Khachatryan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Roberto Luque Avila conducted an unannounced annual inspection to the above facility on 12/05/2024. LPA arrived at the facility at 11:00AM, identified self and met with Haykush Khachatryan, Licensee who guided analyst on a tour of the facility. LPA provided Licensee with a copy of the LIC126 Entrance Checklist to help facilitate the inspection. LPA observed 8 children 1 staff upon arrival. Per Licensee, operation hours are 8AM to 10PM. There are 8 children that are currently enrolled.

The licensee is requesting a capacity increase and has an approved fire clearance from the Los Angeles Fire Department. Fire inspector Ted Debs completed and approved the fire inspection on 11/27/2024.

The licensee is observed to be operating within the license capacity limitations.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

This is a one story home which consists of 3 bedrooms, 3 bathrooms, kitchen, dining room, living room, front yard and backyard (fenced). The children use the bathroom #1 next to the living room. The restroom that children use was observed to be safe and sanitary. Per Licensee, areas off limits to children include: bedroom #3, bathroom #2 and Bathroom #3, these areas are made inaccessible by a child safety gate. The licensee provides food for children in care.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a land line and cellphone that is used and the cellphone stays at the facility during operation hours. Central air ventilation was observed in the home. Safe toys, play equipment and materials were observed.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700159
VISIT DATE: 12/05/2024
NARRATIVE
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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children.

The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 11/08/2024, as indicated on service tag. Smoke and carbon monoxide detectors are located in the living room and were tested and are operable.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 9/11/2024

Licensee states that there are no firearms stored in the home.

Licensee states that if an infant is enrolled, the infant will sleep in the sleeping area where they are constantly supervised. Appropriate sleeping arrangements was observed and child (C1) was seen sleeping in a cot. The child is able to walk and move freely. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. At this time C1 does not have documentation of 15 minute sleep log. The LIC9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700159
VISIT DATE: 12/05/2024
NARRATIVE
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LPA discussed the safe sleep regulations with licensee 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 did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.

Although the licensee has Pediatric First Aid and CPR, it is not from an approved EMSA provider. The licensee currently has a completed Pediatric First Aid and CPR provided by the National CPR Foundation. The licensee's employee (S2) did not have any proof of Pediatric First Aid and CPR have been completed. There are first aid supplies available in bedroom #1.

LPA observed that the Licensee did not have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. However S2 did have their Mandated Reporter Certificate on file.

The licensee did not have proof of immunization against influenza, pertussis, measles and TB clearance.

Children’s records were reviewed, including emergency information and were observed. Child #1, #2, and #3 do not have any record of immunization on file. C1 had a blank immunization record, C2 had no record on file and C3 had a record with their name, parents name, date of birth, sex, ethnicity and race.

LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection. There are no pets on the premises. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700159
VISIT DATE: 12/05/2024
NARRATIVE
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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: https://www.ada.gov/resources/child-care-centers/.

LPA advised that if a child shows signs of illness he/she/they shall be separated from other children. When a child shows signs of illness they are separated in the sleeping area (bedroom #2) and parents are notified to pick up their child.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

While being guided on the tour of the home at 11:29 AM LPA observed volunteer dance instructor in the backyard by an orange tree left alone with children in care. The dance instructor is a volunteer that provides dance classes from 10:30 AM to 11:30AM. During the guided tour the licensee was unaware that the volunteer was still in the home and believed they had left already. The licensee's employee had asked the volunteer to stay with the kids while they went inside.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

LPA advised the Applicant to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov Page 4 of 5
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700159
VISIT DATE: 12/05/2024
NARRATIVE
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Licensee was informed of the MyChildCarePlan.org website; 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.

The following deficiencies listed on the attached deficiency page are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

A notice of site visit was given and must remain posted for 30 days.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility.

Exit interview conducted, appeal rights and report were provided with the licensee Haykush Khachatryan.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/05/2024 03:58 PM - It Cannot Be Edited


Created By: Roberto Luque Avila On 12/05/2024 at 03:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700159

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review , the licensee did not comply with the section cited above. At 1129 LPA observed the volunteer dance instructor left alone with children in the backyard which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/06/2024
Plan of Correction
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The volunteer was instructed to leave and per licensee they will not be left unattended in the future. POC Cleared day of inspection
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/05/2024 03:58 PM - It Cannot Be Edited


Created By: Roberto Luque Avila On 12/05/2024 at 03:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700159

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. Licensee does not have a current Mandated reporter training Available for review during today's inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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Licensee will locate the mandated reporter certifitace on their email, if they are not able to locate it they will re do their mandated reporter training by the POC due date
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in. Licensee does not have record of immunization (MMR,TDAP, and TB Clearance) on file for review during today's inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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Per licensee they will call their provider to get their immunization records and provide them by the POC due date
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
Page: 7 of 9
Document Has Been Signed on 12/05/2024 03:58 PM - It Cannot Be Edited


Created By: Roberto Luque Avila On 12/05/2024 at 03:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700159

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. Although the licensee has a Pediatric First Aid and CPR training available, it is not from an approved EMSA provider. Licensee's employee did not have proof of CPR being done which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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Per licensee, they and their employee will complete their CPR training by an approved EMSA vendor by the POC due date.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. C1,C2, and C3, did not have proof of immunizations on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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Per licensee they will contact parents to provide their childrens immunization records by POC due date
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
Page: 8 of 9
Document Has Been Signed on 12/05/2024 03:58 PM - It Cannot Be Edited


Created By: Roberto Luque Avila On 12/05/2024 at 03:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700159

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. C1 did not have a record for their 15 minute sleep which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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Per licensee they will complete the 15 min sleep log and submit by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
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