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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700275
Report Date: 07/29/2024
Date Signed: 07/29/2024 05:11:03 PM

Document Has Been Signed on 07/29/2024 05:11 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:ILLULIAN FAMILY CHILD CAREFACILITY NUMBER:
195700275
ADMINISTRATOR/
DIRECTOR:		DEVORAH ILLULIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 927-3362
CITY:BEVERLY HILLSSTATE: CAZIP CODE:
90210
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
07/29/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:52 PM
MET WITH:Deroah IllulianTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 7/29/24 Licensing Program Analysts (LPA) Jeanine Lipsey met with applicant, Devorah Illulian. The purpose of the visit was, announce a pre-license visit to ensure that health, safety, and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Homes will be met. Entrance check list was provided. This is an application for a large Family Child Care Home. Applicant is requesting a capacity of 12 children, ages 2-6 years old. The Family Child Care Home will operate Monday – Friday 8:30-3:30pm. Applicant stated that a cell phone, with active service in the home will be the main contact number while children are in care.

The applicant provided proof of control of property. The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children.

LPA discussed the LIC282 Affidavit Regarding Liability Insurance with applicant. If applicant does not have insurance this form needs to be filled out and put in the child folder.

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. LPA Lipsey observed the following required postings: LIC 610A Emergency Disaster Plan, PUB 394 Notification of Parents’ Rights Poster, and LIC 9148 Earthquake Preparedness Checklist. LPA advised, once licensed, the facility license shall be posted. LPA advised all LIC 9213 Notice of Site Visits shall be posted for 30 days after each site visit. LPA advised, any licensing report documenting a Type A citation must be posted for 30 days. LPA advised a fire/disaster drill log shall be available and performed at least every six months.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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: ILLULIAN FAMILY CHILD CARE
FACILITY NUMBER: 195700275
VISIT DATE: 07/29/2024
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 The applicant has completed preventive health and safety/Childhood Nutrition/ Lead Exposure Prevention on 3/19/23 and Mandated Reporter training completed on 5/30/23. The applicant has current pediatric CPR/First Aid training completed on 3/17/23. The fire inspection was completed on 7/25/24.

Applicant, guided LPA on a tour of the home. All areas identified on the home sketch were inspected, including but not limited to off limit areas. Per applicant off limit areas will be in inaccessible. This home consists of 3 bedrooms, 3 bathrooms, living/dining room, kitchen, laundry room, den and library. Per applicant, the children will use the following areas: Living/Dining room, den, kitchen and bathroom #1. The children will also use the pool house located in the backyard for extra activities. Pool house has a bathroom, kid size tables & chairs, a fire extinguisher, and smoke/carbon monoxide detector. There is a second pool house in the backyard that is off limits to the children. The house used for the spouse’s business. The spouse is a Rabi, and the house is used for community gatherings on the weekends. The door is locked to render the house inaccessible to children in care.

The entire second floor is off limits to the children in care. Kitchen cabinets and drawers were observed with a locking mechanism. The stove, refrigerator, sink and counter space area were observed. The bathroom, with working toilet and sink was observed to be free of hazards and good repair. LPA observed a fireplace barricaded by metal gate rendering it inaccessible to children in care.

The den was observed to have children size tables, chairs, toys and variety of age-appropriate materials. There were no fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission. Cots were observed for napping. LPA observed emergency water in the kitchen and first aid kit in the den. The LPA observed the home was clean and orderly, with heating and ventilation for safety and comfort. Per applicant, children will sleep in the Living room and eat in the den. LPA observed applicant test the carbon monoxide/smoke detectors in the dining room, the laundry room, and den, they were in good working condition. LPA observed a fire extinguisher (2A10BC) in the kitchen and pool house with the date of purchase of 6/20/24.


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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
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: ILLULIAN FAMILY CHILD CARE
FACILITY NUMBER: 195700275
VISIT DATE: 07/29/2024
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LPA observed there were no defects or conditions which might endanger the children. All electrical outlets in the home were covered. The LPA observed there were no poisons, detergents, cleaning compounds, medicines, and other items which could pose a danger, accessible to children. Per applicant, there are no weapons or firearms of any kind in the facility currently. The LPA did not observe any weapons.

LPA advised, mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. Mattresses shall be made specifically for the size crib or play yard in which they are placed.

LPA advised, cribs or play yards shall be free from all loose articles, objects, bumper pads shall not be used, and there shall be no objects hanging above or attached to the side of the crib. Per Health and Safety Code Sections 1596.846(b) and (c), LPA advised, baby walkers, bouncers, Johnny jumpers, trampolines, and saucer chairs are not permitted.

LPA discussed when a child shows signs of illness, he/she shall be separated from other children until the nature of the illness determined. If it is a communicable disease, he/she shall be separated from other children until the infectious stage is over. The Isolation area will be located in living room.

Children will utilize the back yard to play. Outdoor play area was observed to be fenced, and Per applicant, when children are having outside time, they will ensure 100% supervision and never leave children unattended.

LPA observed a pool located in backyard. Pool was observed to be inaccessible by the use of surrounding the pool with a fence. The fence was observed to be 5 feet. Fence was observed to not obscure the pool from view. Pool gate was observed to swing away from the pool, self-close, and have a self-latching device located no more than six inches from the top of the gate.

LPA discussed, the applicant shall be present in the home and shall ensure that children in care and always supervised. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
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: ILLULIAN FAMILY CHILD CARE
FACILITY NUMBER: 195700275
VISIT DATE: 07/29/2024
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Applicant 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.

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.

On 3/7/24, 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.

LPA discussed, Smoking is prohibited on the premises of a family childcare home as specified in Health and Safety Code Section 1596.795(a). A baby walker shall not be allowed on the premises of a family childcare home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.



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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
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: ILLULIAN FAMILY CHILD CARE
FACILITY NUMBER: 195700275
VISIT DATE: 07/29/2024
NARRATIVE
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LPA discussed the safe sleep regulations with applicant 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 applicant, 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.

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.

The following items need to be in place before a license will be considered.

1. Applicant will purchase a gate for the stairs and send picture proof the gate installed by 8/28/24.

Exit interview conducted, and report was reviewed with the applicant, Levi Illulian, spouse of Devorah Illulian.



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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
LIC809 (FAS) - (06/04)
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