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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700168
Report Date: 12/05/2024
Date Signed: 12/05/2024 03:30:18 PM

Document Has Been Signed on 12/05/2024 03:30 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:DAVTYAN FAMILY CHILD CAREFACILITY NUMBER:
195700168
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
12/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:35 PM
MET WITH:Elmira Davtyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Annual Random Visit Conducted In Armenian

On 12/05/2024 Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit. The purpose of this visit 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 was present with six children. The facility has been licensed for Small (8) Family Child Care home license since October of 2023. The licensee is applying for an increase of capacity; Large Family Child Care Home license for a maximum capacity of 14. The Fire clearance was granted on 11/26/2024 by LA City Fire Prevention Bureau. Hours of operation for the facility are 6:30 AM- 8:00 PM Monday- Friday. Ages served are 2 years - 14 years old. There is no pool, spa or other bodies of water on the premises. Licensees' home shares the same property as the back house with different addresses (7732 Varna Ave, North Hollywood, CA 91605). Entrance Checklist was provided to the applicant. Applicant stated that a cell phone with active service in the home will be the main contact number 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, 2 bathrooms, living room, laundry/storage room (in the garage), kitchen, and converted attached garage. LPA observed Fire Extinguisher (3A40BC) in the kitchen that was serviced on 11/01/24. Smoke Detector/Carbon Monoxide detectors were tested and are operable. The First Aid kit was observed and complete.

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

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: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700168
VISIT DATE: 12/05/2024
NARRATIVE
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 Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. Applicant was informed that her children under 10 years of age, count in her capacity whenever they are present. The bathroom by the back exit door and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care. All sharp items and kitchen knives are kept in kitchen cabinet with child safety latch. The outdoor play area/back yard was inspected. The backyard is surrounded by property walls. Children's outdoor play equipment and toys are age appropriate and in good repair. Cleaning supplies and medications are kept inaccessible to children. There is a fireplace in the living room with a screen. The home is clean and orderly with central AC/Heating and ventilation for safety and comfort. LPA observed safe toys and play equipment age appropriate for childcare. Licensee uses cell phone for the childcare and was reminded that the cellphone must always remain in the home when children are in care. During the visit LPA did not observe any weapons or firearms; Licensee states there are no weapons or firearms in the home.

LPA observed Licensee's Pediatric CPR and Pediatric First Aid certifications (completed on 07/22/2024) and current Mandated Reporter Training Certificate (completed on 07/10/2023).



The fire drills are done every month. Last drill was conducted on 11/13/2024. Licensee provides meals and snacks. LPA discussed food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date.

LPA observed by the entry door the Parent Board with all necessary posting required ( Facility License (LIC 203), Emergency Disaster Plan (LIC610A), Notification of Parents' Rights Poster (PUB 394), If You see Something Say Something poster. Child Care Facility Roster (LIC9040) was on file.
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, LIC702, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card. Page 2
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
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)
Page: 2 of 4
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: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700168
VISIT DATE: 12/05/2024
NARRATIVE
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A review of records indicates that Licensee has immunization records on file for influenza, pertussis and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.



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.

There are no infants enrolled at this time. LPA discussed the safe sleep regulations with licensees 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.
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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
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: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700168
VISIT DATE: 12/05/2024
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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/.

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.

During the exit interview, Licensee Elmira Davtyan informed that there are no Registered Sex Offenders living in the facility.

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

Exit interview conducted and report was reviewed with Licensee Elmira Davtyan.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
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)
Page: 4 of 4