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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700369
Report Date: 10/24/2024
Date Signed: 10/24/2024 11:19:52 AM

Document Has Been Signed on 10/24/2024 11:19 AM - 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:KEROBYAN FAMILY CHILD CAREFACILITY NUMBER:
195700369
ADMINISTRATOR/
DIRECTOR:		ARMAN KEROBYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 287-1465
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/24/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:25 AM
MET WITH:Arman Kerobyan, ApplicantTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Silva Garibyan conducted a change of location pre-licensing inspection on 10/24/2024 at 7:25AM. LPA met with Arman Kerobyan, applicant who guided analyst on a tour of the facility. Aplicant has applied for a large capacity license. Licensee is currently licensed as a small Family Child Care Home under facility # 197495063 (Effective Date: 06/29/2022). The licensee has an approved fire clearance. Per licensee, operation hours will be Monday to Friday from 6:00 am to 7:00 pm. Licensee states she will care for children newborn to 15 years of age. Entrance Checklist was provided to the licensee. Licensee stated that a cell phone with active service in the home will be the main contact number while children are in care. Licensee's home shares the same property as the converted garage/guest house with same address. The guest house will not have access to the Applicants' home and yard area which is separated by a six feet plastic fence. 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, 3 bathrooms, living room(1), child care room/living room(2), and kitchen. Parents and children will use the main entry door leading to the living room(1). All electrical outlets in the home were covered. LPA observed child safety latches on all kitchen cabinet doors and drawers. Bedrooms were observed and inspected. Applicant has designated Bedroom (1), Bedroom (2), Bathroom (2), Converted Garage/Guest House as OFF LIMIT to the children in care. LPA observed bedroom bathroom, and kitchen doors with safety knob/locks making off limit areas inaccessible. Kitchen cabinets were observed and inspected. The stove, refrigerator, sink and counter space area were observed and inspected. Knifes and sharp objects observed to be made inaccessible to the children in care. The bathrooms that children will use is in the hall way and in Bedroom(3). A toilet, a sink, and a shower was observed in both bathrooms. The bathrooms were observed to be free of hazards. Page 1
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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
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: KEROBYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700369
VISIT DATE: 10/24/2024
NARRATIVE
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Children will utilize the back yard to play. The yard is fully fenced with no bodies of water. Applicant is stating that when children are having outside time she will ensure 100% supervision and never leave children unattended. There is no pool, spa or other bodies of water on the premises.

Applicant has submitted a disaster plan. The applicant has completed preventive health and safety/Childhood Nutrition/ Lead Exposure Prevention and Mandated Reporter training (completed on 02/09/2024). The applicant has current pediatric CPR/First Aid training completed on 02/08/2024.

Living room(1), Living room(2)/Child Care Room, and Bedroom (3) observed to have children size tables, chairs, and variety of age appropriate materials. Living Room(2)/Child Care Room observed to have a play yard and 15 cots. LPA observed emergency water and first aid kit in the kitchen. Children will eat in Living Room(1) and in Living Room(2)/Child Care Room, the and sleep in Bedroom (1). LPA observed applicant test the carbon monoxide/smoke detectors in the kitchen. LPA observed four Fire Extinguishers (2A10BC) in the living rooms and two bedrooms that was purchased on 08/14/24. Per applicant, there are no weapons or firearms of any kind in the facility at this time. LPA did not observe any weapons.

Licensee has the required documents posted in the FCCH: Emergency Disaster Plan (LIC610A), Notification of Parents' Rights Poster (PUB 394), If You see Something Say Something poster, Safe Sleep poster.

The applicant rents the home and provided proof of control of property ( Residential Lease Agreement).

Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).



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

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
Page: 2 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: KEROBYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700369
VISIT DATE: 10/24/2024
NARRATIVE
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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.
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.

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. Entrance Checklist was provided to the applicant.


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

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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: KEROBYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700369
VISIT DATE: 10/24/2024
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-andresources/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.

On 08/06/2024, 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.

Licensee was 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.

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. Page 4
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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: KEROBYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700369
VISIT DATE: 10/24/2024
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Applicant was informed that the following is pending licensure and needs to be corrected within 30 days from the date of this report:

1) TB test results for Guest house tenants
2) Fingerprint Clearance for Guest house tenants



Exit interview conducted and report was reviewed with the applicant, Arman Kerobyan.

Page 5
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5