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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418984
Report Date: 07/19/2023
Date Signed: 08/04/2023 04:38:32 PM

Document Has Been Signed on 08/04/2023 04:38 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:KALYAN FAMILY CHILD CAREFACILITY NUMBER:
197418984
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
07/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Astgik KaylanTIME COMPLETED:
02:00 PM
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On 7/19/2023 Program Analysts (LPA), Judy Laureano conducted an unannounced Annual Required Inspection at 6302 Farmdale Avenue, North Hollywood, CA 91606. LPA was greeted by licensee Astgik Kalyan. During today’s inspection the following was observed: 5 children and licensee providing care and supervision.

Facility operates Monday through Sunday from 8:00 a.m. to 12 a.m. Licensee is available to care for children seven days a week. Currently licensee is available to take in children ages 3 months old to 12 years old. Facility is Small Family Child Care Home with a max capacity of 8. Facility currently has children attending care from 8 am to 6:00 p.m. and does not have any child under the age of 12 months.

LPAs toured the home inside and outside. The facility is located in a single family home with 3 bedrooms, 2 bathrooms, a living room, dining room and kitchen area. The home has an enclosed front yard and back yard.

Licensee confirmed children use bedroom and bathroom closest to the kitchen as day care space. Licensee confirmed children nap eat and nap in the space. Licensee confirmed families enter the home through the side gate, through the back yard and enter through the sliding doors. The space was observed with age appropriate toys an materials. All necessary posting was observed in the parent board located near the bathroom. LPA observed children getting ready for nap time.

The following area are OFF LIMITS to the children in care: bedroom 1, bedroom 2, bathroom 2 located in the hallway next to the living room/dining room area. Kitchen, living room with barricaded fire place and dining room have all been designated as OFF LIMITS. LPA reminded licensee to ensure all areas that have been designated as OFF LIMITS need to have doors closed doors and made inaccessible when children are present.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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: KALYAN FAMILY CHILD CARE
FACILITY NUMBER: 197418984
VISIT DATE: 07/19/2023
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Licensee confirmed home uses an the enclosed back yard and side yard of the home. Space was observed to have a wooden play structure with soft cushion materials.

Bathroom that children use is located in the bedroom designated for day care use. LPA inspected the bathroom and did not observe any medications, toxins or cleaning compounds that would pose a risk to children in care.



LPAs observed licensee test the carbon monoxide and smoke detector in the home. LPA observed 1 working fire extinguisher mounted in the kitchen. All cabinets in the kitchen were observed to have safety latches; making the content inaccessible to the children in care. LPA confirms home provides meals and snacks. LPA discussed the importance of maintaining a system where allergies and food restrictions are noted.

No swimming pools or bodies of water were observed in the space. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Licensee observed a barricaded fire place in the living room area; living room area has been designated as OFF LIMITS.

LPAs observed cleaning compounds locked under the kitchen sink cabinet; content made inaccessible to the children in care.

Licensee currently does not administer medication. Adequate heating and ventilation for safety and comfort were observed in the space. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number 323-228-6959.

Safe Sleep regulations were discussed due to program being available for infant care in the future. Currently licensee does not have any children under the age of 12 months. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Infants up to 12 months of age are placed on their backs for sleeping. Individual Infant Sleeping Plan has been completed. LPA provided licensee with a sample sleeping log to use a reference.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: KALYAN FAMILY CHILD CARE
FACILITY NUMBER: 197418984
VISIT DATE: 07/19/2023
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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained during today’s inspection.

LPA reviewed licensee’s file and observed file was complete. LPA reviewed Mandated Reporter training and observed training was taken on 2/16/2023. Licensee’s CPR and First Certification was taken on 2/19/2023. LEAD Prevention was taken on 7/16/2021. LPA discussed all necessary forms needed in each staff file and children’s file. LPA provided licensee with a current copy of the LIC 311D and a sample packet to use as a reference when auditing files. LPA reviewed 3 children’s files and observed files to be complete.

Family Child Care Homes 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.

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.

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/.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee, Astgik Kalyan was 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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Astgik Kalyan.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
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