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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700169
Report Date: 09/10/2025
Date Signed: 09/10/2025 04:30:18 PM

Document Has Been Signed on 09/10/2025 04:30 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:OVSEPJANOVA FAMILY CHILD CAREFACILITY NUMBER:
195700169
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 11DATE:
09/10/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Lia Ovsepjanova, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 09/10/2025, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Case Management -Other Visit at 20213 Lassen Street, Chatsworth, CA 91311. Licensee cares for children from ages birth to 12-year-olds. Facility hours of operation are Monday to Friday from 06:00AM to 11:00PM.

LPA arrived at the facility at 02:15PM, identified self and met with Lia Ovsepjanova, Licensee, who guided analyst on a tour of the inside and outside of the facility. There were 11 children present at upon arrival and 4 of the 11 children were infants. LPA observed the number of children present at the facility exceeded the License Capacity of 8 children. The facility was not operating as specified in Section 102416.5(c) Staffing Ratio and Capacity, this is a repeat violation and a Civil Penalty of $1,000.00 will be assessed today. This poses an immediate health, safety or personal rights risk to persons in care.

The purpose of the visit was to review pending documentation for a capacity increase.

LPA observed Gohar Sargsyan, an adult supervising children without Criminal Record Clearance associated to the facility. The facility was not operating as specified in Section 102370 (d)(1) Criminal Record Clearance and a $300.00 will be assessed today. This poses a potential health, safety or personal rights risk to persons in care.

LPA conducted a review of children's records and found that 2 of 11 records were not readily available for review upon request. The facility was not operating as specified in Section 102421(b) Child's Records, this poses an potential health, safety, or personal rights risk to persons in care.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169
VISIT DATE: 09/10/2025
NARRATIVE
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Based on observations by the LPA, the deficiencies listed on the attached LIC 809D page are being cited.

LPA informed Lia OvsepJanova, Licensee that Type A citation shall be posted for 30 consecutive days as there are immediate risk(s) to the health, safety, or personal rights of children in care.

LPA informed Lia Ovsepjanova, Licensee that this report dated 09/10/2025 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care

Also, LPA Calvillo informed the facility representative to provide a copy of this licensing report dated 09/10/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Lia Ovsepjanova, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 09/10/2025 04:30 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 09/10/2025 at 03:37 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: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/11/2025
Section Cited
CCR
102416.5(c)

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102416.5(c)Staffing Ratio and Capacity (c) The total licensed capacity for a Small Family Child Care Home shall not exceed eight children.

This requirement is not met as evidenced by:
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Per Licensee they will maintain the capicity limit for eight (8) children per the facility license. Licensee will notify parents of childrent enrolled about exceeding the capcity limit for the facility by providing a copy of the facility report and collecting the LIC 9224 Acknowledgement of Receipt of Licensing Reports Form by the plan of correction due date of 09/11/2025.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in the total number of children present was 11 which is above the capacity limit of eight (8) children which poses an immediate health, safety or personal rights risk to persons in care.
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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.
Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:
Elicia Calvillo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 09/10/2025 04:30 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 09/10/2025 at 03:43 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: OVSEPJANOVA FAMILY CHILD CARE
FACILITY NUMBER: 195700169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/12/2025
Section Cited
CCR
102370(d)(1)

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102370 (d)(1)(d) All individuals subject to a criminal record review ...shall prior to working, residing, or volunteering in a licensed facility: (1)Obtain a California clearance or a criminal record exemption ...This requirement is not met as evidenced by
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Licensee stated they will complete the Criminal Record Clearance or Transfer by the plan of correction due date of 09/12/2025 and email LPA when it is completed.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that Gohar Sargsyan did not have a criminal record transfer which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
09/15/2025
Section Cited
CCR102421(b)

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102421 (b) Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requirement is not met as evidenced by
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Licensee stated they will have the parents complete the children's record by the plan of correction due date 09/16/2025 and email LPA a copy.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that 2 of 11 children's records were not readily availble upon request which poses an immediate health, safety or personal rights risk to persons in care.
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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.
Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:
Elicia Calvillo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2025


LIC809 (FAS) - (06/04)
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