197493673-12-22-2023-58-CC-SGAN-CYRRWG-20231222122308

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493673
Report Date: 12/22/2023
Date Signed: 12/22/2023 12:25:03 PM

Document Has Been Signed on 12/22/2023 12:25 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:	ANTONYAN FAMILY CHILD CARE		FACILITY NUMBER:	197493673
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 7	CENSUS: 1	DATE:	12/22/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Anahit Antonyan, Licensee		TIME COMPLETED:	12:25 PM

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	Required Visit Conducted In Armenian On 12/22/2023 Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Required visit. The purpose of this visit is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes. The facility has been licensed for Small (8) Family Child Care home license since March of 2018. The licensee is applying for an increase of capacity; Large Family Child Care Home license for a maximum capacity of 14. The Fire clearance was granted on 12/06/2023 by LA City Fire Prevention Bureau (inspector Shawn Connolly). The licensee has installed the pull fire alarm that is required for large Family Child Care Homes. Present during today's inspection was Licensee and one infant. Hours of operation for the facility is 24 hours Monday-Sunday(updated application was provided) and closed all major holidays. Licensee provides services for children newborn to 14 years old. Family members residing in the home include the licensee, licensee's husband, and licensee's two adult children. Licensee's home is a single story, 3 bedroom, 2 bathroom home with a living room, dining/kitchen area, attached converted garage, and laundry room accessible from the garage. LPA inspected the garage. The licensee is fully aware that children may not eat or sleep in the garage. Children eat and sleep in the living/dining room. One bedroom is used for napping. Page 1 of 5

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

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: ANTONYAN FAMILY CHILD CARE	FACILITY NUMBER: 197493673
	VISIT DATE: 12/22/2023

NARRATIVE

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Bedroom 2, bedroom 3, and bathroom 2 in bedroom 1 are off limits to the children in care. The children have access to the bathroom located in the hall way. There is no pool, spa or other bodies of water on the premises. The home was observed to have an enclosed front yard and back yard. The front gate was observed to be locked and a ring door bell installed. LPA toured the backyard and found it to be fully fenced. LPA observed two storage sheds in the back yard. The sheds were observed to be locked. There is a bird in the FCCH which is caged and located in the back yard. Children in care do not have direct access to the birds or the bird cage. There is a dog (Boston Terrier) in the FCCH. Dog is kept in the separated area of the back yard which is off limits to the children in care.
LPA observed by the entrance 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.

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, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card, LIC 9227/Individual Infant Sleeping Plan, and sleep log.

The living room and dining room area were observed to have age appropriate toys. A children size table and six chairs were observed in the living room. Nine napping cots and one play yard were observed in Bedroom 1. Page 2 of 5

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

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: ANTONYAN FAMILY CHILD CARE	FACILITY NUMBER: 197493673
	VISIT DATE: 12/22/2023

NARRATIVE

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LPA observed licensee test the carbon monoxide and smoke detector in the dining/kitchen area. The Fire Extinguisher (2-A:10-B:C) is mounted on the wall in the living room. All electrical outlets were observed to be covered. Smoke detector is located in the hallway of the home. Per licensee, there are no weapons or firearms of any kind in the facility at this time. LPA did not observe any weapons.

The bathroom that children use is located in the hall way. LPA observed one toilet, one sink, and one shower in the bathroom. LPA observed a shower free of shampoos and soaps. The bathroom was observed to be free of hazards. Under the sink cabinet was observed to have a safety latch making the contents inaccessible to the children in care.
The kitchen was observed and inspected. All lower cabinets were inspected and observed to have safety latches, making the contents inaccessible to the children in care. Under the sink cabinet was observed to have cleaning supplies and LPA observed a safety latch, making the content inaccessible. All knives and sharp objects are stored in a drawer that was observed to have a safety latch making the items inaccessible. Licensee provides meals and snacks. LPA discuss food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date.

The licensee has completed Mandated Reporter training ( completed on 06/22/22). The licensee has current pediatric CPR/First Aid training completed in January of 2022. Licensee owns the home and provided proof of control of property by presenting mortgage statement.
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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

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: ANTONYAN FAMILY CHILD CARE	FACILITY NUMBER: 197493673
	VISIT DATE: 12/22/2023

NARRATIVE

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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.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [or facility representative] 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.
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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

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: ANTONYAN FAMILY CHILD CARE	FACILITY NUMBER: 197493673
	VISIT DATE: 12/22/2023

NARRATIVE

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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/.

Licensee 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.

During the exit interview, the licensee Anahit Antonyan, confirmed that there are no Registered Sex Offenders living in the facility. RSO profile in FAS was completed on 10/16/2023.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Anahit Antonyan

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

LIC809 (FAS) - (06/04)

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