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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700428
Report Date: 01/28/2025
Date Signed: 01/28/2025 03:29:48 PM

Document Has Been Signed on 01/28/2025 03:29 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:SARGSYAN FAMILY CHILD CAREFACILITY NUMBER:
195700428
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/28/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Anna Sargsyan, ApplicantTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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Pre-Licensing Visit Conducted In Armenian
Licensing Program Analyst (LPA) Silva Garibyan conducted a pre-licensing inspection on 01/28/2025 at 11:20 AM. LPA met with Anna Sargsyan, applicant who guided analyst on a tour of the facility. The applicant is requesting small family child care home license with a capacity of 08. Per applicant operation hours will be Monday to Friday 8:00 AM-9:00 PM. Applicant will care for children ages newborn to 13 years old. 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. Applicant's home shares the same property as the back house with a different address (6337 Elmer Ave, North Hollywood, CA 91606). The properties are separated by a six feet fence. All areas identified on the facility sketch were inspected, including but not limited to off limit areas. The home is equipped with a central heating/cooling system. This is a single story home that consists of three bedrooms, two bathrooms, Living Room (1), Living Room (2)/ Day Care room, and kitchen. Parents and children will use the main entry door leading to Living Room (1). LPA observed child safety latches on all kitchen cabinet doors and drawers. Bedrooms were observed and inspected. Applicant has designated Bedroom (1), Bedroom (2), and Bathroom (2) OFF LIMITS to the children in care. LPA observed bedroom knobs with locks making bedrooms 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 bathroom (1) is in Bedroom (3)/Day Care room. A toilet, a sink, a bath tub, and a shower was observed in the bathroom. The bathroom was observed to be free of hazards. Sleeping area for children was observed in Bedroom (3)/Day Care Room. Page 1
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700428
VISIT DATE: 01/28/2025
NARRATIVE
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 Electrical outlets have safety covers installed. 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 current pediatric CPR/First Aid training completed on 03/27/2024 and Mandated Reporter Training completed 08/05/2024

Living/Dining room (2) observed to have children size tables, chairs, and variety of age appropriate materials. Bedroom (3) observed to have a play yard and six cots. LPA observed emergency water and first aid kit in the kitchen. Children will eat in Living/Dining room (2) and sleep in Bedroom (3). LPA observed applicant test the carbon monoxide/smoke detectors in all bedrooms and in the hall way. LPA observed a Fire Extinguisher (1A10BC) in the kitchen. 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: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700428
VISIT DATE: 01/28/2025
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: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700428
VISIT DATE: 01/28/2025
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 10/08/2024, 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.

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

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700428
VISIT DATE: 01/28/2025
NARRATIVE
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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) Purchase receipt for the correct size fire extinguisher (2A10BC). Picture via email.
2) Pediatric CPR and Pediatric First Aid from an EMSA approved provider ( the applicant currently has a completed Pediatric First Aid and CPR provided by the National CPR Foundation).




Exit interview conducted and report was reviewed with the applicant, Anna Sargsyan.

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

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5