<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418798
Report Date: 08/19/2024
Date Signed: 08/19/2024 11:06:20 AM

Document Has Been Signed on 08/19/2024 11:06 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:MOVSESYAN FAMILY CHILD CAREFACILITY NUMBER:
197418798
ADMINISTRATOR/
DIRECTOR:		MOVSESYAN, KARINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 919-4671
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/19/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:20 AM
MET WITH:Karine Movsesyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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
Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of a Required- 3 year visit . LPA met with the licensee and toured the home inside and outside at 7:30AM on 08/19/2024. Licensee was present with six children and one assistant. LIcensee's home is a two story 4 bedroom, 3 bathroom home with living room, kitchen and play room at the rear of the facility. Licensee has a pool in the back yard that is properly fenced with a gate that opens away from the pool area and self closes and self latches. Main care is provided in the Family room/play room at the rear of the home. This room has its own entrance. Parents enter the facility from the right side of the home and enter the play room. Children eat and nap in Family room/play room. Children use the bathroom located in the family room. Off limit areas include the entire second floor, all three bedrooms on the first floor, the kitchen and living room. There are safety gates at the staircase leading to the second floor and in the hallway to separate the off limit rooms. Children play in the back yard which is fenced. The main entry door is not used to enter the facility. Parents and children use the back door leading to the play room. There is another day care home capacity 14 located in the front of the home with a different address 123329 Lull Street, North Hollywood. CA 91605, license # 197494202. LPA observed the yards separated. LPA toured the backyard area to ensure that the pool fencing meets the Title 22 requirements. LPA toured all areas used by children during this inspection. Page 1
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2024
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 4
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: MOVSESYAN FAMILY CHILD CARE
FACILITY NUMBER: 197418798
VISIT DATE: 08/19/2024
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
26
27
28
29
30
31
32
 Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. The bathroom and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care. The outdoor play area was inspected. Children's outdoor play equipment and toys are age appropriate and in good repair. LPA observed the yard to be fully fenced. The Fire Extinguisher (3A-40-BC, Date of service: 02/28/2024)) is mounted on the wall in the play room. There is a working smoke/carbon monoxide detectors located in the living room.
LPA observed tables, chairs and napping equipment (14 cots). Licensee reports she has no firearms or weapons in the home. LPA also observed Licensee's and Assistant's current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 10/2025) and Licensee's and Assistant's Mandated Reporter Training Certifications(completed 02/13/2024).
The bathroom and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care. Children play in the front yard. LPA observed the yard to be clean, free of debris, and fully fenced. The fire drills are done twice a year. Last drill was conducted on 8/12/2024. Licensees provide meals and snacks. LPA discuss food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date. Licensees stated that a cell phone with active service in the home will be the main contact number while children are in care.
LPA observed in the play room the Parent Board with all necessary posting required ( Facility License (LIC 203), Emergency Disaster Plan (LIC610A), Notification of Parents' Rights Poster (PUB 394), If You see Something Say Something poster, Car Seat Safety poster). Child Care Facility Roster (LIC9040) was on file. Page 2
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: MOVSESYAN FAMILY CHILD CARE
FACILITY NUMBER: 197418798
VISIT DATE: 08/19/2024
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
26
27
28
29
30
31
32
A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC702, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card.

A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.



Licensee was reminded that all adults 18 and over living or working in the home, 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. Page 3
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: MOVSESYAN FAMILY CHILD CARE
FACILITY NUMBER: 197418798
VISIT DATE: 08/19/2024
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
26
27
28
29
30
31
32
No infants are enrolled at this time. LPA discussed the safe sleep regulations with licensees 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 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.
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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
Licensees were informed of the MyChildCarePlan.org website; 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.
During the exit interview, the licensee Karine Movsesyan confirmed that there are no Registered Sex Offenders living in the facility.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Karine Movsesyan.

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

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4