195700173-8-31-2023-58-CC-JLAO-CV8VS9-20230831164110

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195700173
Report Date: 08/29/2023
Date Signed: 08/31/2023 04:41:41 PM

Document Has Been Signed on 08/31/2023 04:41 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:	ZAKEVOSYAN FAMILY CHILDCARE		FACILITY NUMBER:	195700173
ADMINISTRATOR:	MARGARIT ZAKEVOSYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 210-2629
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91601
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	08/29/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Margarit Zakevosyan and Nshan Auilian		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/29/2023 Licensing Program Analyst (LPA) Judy Laureano conducted an announced inspection with Margarit Zakevosyan and Nshan Auilian for the purpose of a pre licensing inspection of 5761 Vineland Avenue, North Hollywood, CA 91601. The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance with California Tittle 22 Regulations and California Health and Safety Codes. Present during today’s inspection was applicant only and adult Nshan Auilian who will be added as a colicensee. Per the application, at this time, the ages the applicant wishes to provide services for are children birth to 13 years old Monday- Friday from 8:00 a.m. to 11:00 p.m. Applicants are available for evening and infant care. Fire clearance was completed on 8/25/2023 by Inspector Shawn Connolly. This is a change of location, applicant has been licensed before at 6229 Fair Avenue, North Hollywood, CA 91606 with facility number 197493112. Applicants were informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes. Applicants are applying for a Large Child Care License with a max capacity of 14. Copy of mortgage statement was provided and filed. Living in the home is applicants; M. Zakevosyan and N. Auilian. LPA toured the home inside and outside. The facility is single family home with 2 bedrooms, one bathroom, living dinning room area, attached garage which has been converted and a front and side yard. Home is located on the corner of vineland and hatteras and parent will be able to access the home from the front gate or side gate. The front yard is enclosed with a metal gate and parents will access the home through the main entrance. Once you enter the home you are led to the living room and dining room areas that have been designated as day care space. LPA observed children size tables and chairs, children’s cubbies and reading area. LPA observed a parent board near the entrance of the home with the necessary paperwork posted. LPA observed the

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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: ZAKEVOSYAN FAMILY CHILDCARE	FACILITY NUMBER: 195700173
	VISIT DATE: 08/29/2023

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fire pull station in the space. The area was observed to have a sliding door gate that gives access to the side of the home. Door will remain closed during hours of operation and/or when children are present. Applicants confirmed children will eat and nap in the living/dinning room area space.

Next to the living room area, LPA observed a hallway that leads to bedroom 1, bathroom and bedroom 2. LPA observed bedroom 2 designated as OFF LIMITS to the children in care, door will remain closed during hours of operation.

Bedroom 1, designated as day care room was observed with age appropriate toys. LPA observed applicants test the carbon monoxide and smoke detector in the space. LPA observed cots in the space. Outside bedroom 1, LPA observed a linen closet.

The bathroom that children will use was observed and inspected. A toilet, sink and tub were observed. LPA reminded applicants to ensure all electrical outlets are covered.

Kitchen is located outside the dining room/living room area. Kitchen area has been designated as OFF LIMITS to the children in care. Applicants confirmed that home will be providing meal and snacks. LPA encouraged applicants to contact their local Resource and Referral agency, CCRC, to inquiry about any food programs. Kitchen was observed to have a side door that leads to a storage closet that leads to the side of the home. LPA advised applicants to add a safety door knob cover to the door to ensure children do not have acess. LPA observed and inspected all kitchen cabinets and counter space. LPA advised applicants to remove all cleaning compounds from under the sink cabinet or add a safety latch. LPA observed a working fire extinguisher mounted next to the refrigerator. LPA advised applicants to add a safety gate outside the kitchen.

Next to the kitchen, LPA observed the converted space/attached garage. Area has been designated as OFF LIMITS to the children in care. Applicants agreed that care and supervision will not occur in the space. LPA observed a side door that leads to the side of the home. Side of the home has been designated as OFF LIMITS to the children in care.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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: ZAKEVOSYAN FAMILY CHILDCARE	FACILITY NUMBER: 195700173
	VISIT DATE: 08/29/2023

NARRATIVE

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Applicants confirm the front yard and the side cemented area closest to the street is designated as outdoor space. LPA observed both areas to be gated. Front yard of the home was observed to have artificial turf and a variety of outdoor equipment for children to use. Applicants confirmed the side of the yard will be used for children to ride their bikes.
The following area are designated as OFF LIMITS:
1. Bedroom 2- door will remain closed during the hours of operations
2. Kitchen and converted area/attached garage and
Side yard.

The following requirements shall be submitted by 9/12/2023. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.
The following corrections need to be completed prior to licensure:
1. Bottom cabinet- all cleaning solutions will be removed.
2. Safety door knob cover added to the storage door that gives access to the side of the home.
3. Safety gate placed between the kitchen and dining/living room area.
4. Immunization records for applicants: MMR and Tdap
5. Remove water from small fountain the the front yard.

Exit interview was conducted with applicants Margarit Zakevosyan and Nshan Auilian.

Applicants were 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.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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: ZAKEVOSYAN FAMILY CHILDCARE	FACILITY NUMBER: 195700173
	VISIT DATE: 08/29/2023

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) 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.

LPA reviewed with applicants 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. PIN 22-05-CCP Page Eight

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-and-resources/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.

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.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC809 (FAS) - (06/04)

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