197494148-10-11-2024-58-CC-SGAN-D9XPJA-20241011112112

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494148
Report Date: 10/11/2024
Date Signed: 10/11/2024 11:21:20 AM

Document Has Been Signed on 10/11/2024 11:21 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:	KASHNANYAN FAMILY CHILD CARE		FACILITY NUMBER:	197494148
ADMINISTRATOR/ DIRECTOR:	ANNA KASHNANYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 522-8224
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 4	CENSUS: 3	DATE:	10/11/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Anna Kashnanyan, Licensee		TIME VISIT/ INSPECTION COMPLETED:	11:20 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	Annual Random Visit Conducted In Armenian 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 8:00 AM on 10/11/2024. Licensee was present with three children and one assistant. Per Licensee, at this time the ages service is being provided is 6 months old to 13 years old with the hours of operation of Monday- Saturday from 7:00 a.m. to 11:00 p.m. Licensee's home shares the same property as the attached house with a different address (12811 Vose Street, North Hollywood , CA 91605). The attached house is occupied by licensee's son. The attached house has no access to the licensee's home and yard area which is separated by a plastic fence. Licensee's home is a single story, 4 bedroom, 2 bathroom house with a living room, kitchen, child care room, and laundry room ( adjacent to the day car room) . There is no pool, spa or other bodies of water on the premises. The three bedrooms, the bathroom, living room, and the kitchen in the front of the house, and the laundry room in the back are off limits to the children in care. Glass door is installed by the stairs to make the front of the house inaccessible. The main entry door is not used to enter the facility. Parents come through the side door and walk toward the home. Upon entering, a cemented area guides you to the back yard that has been designated for outdoor space for the day care. . There is no pool, spa or other bodies of water on the premises. LPA toured all areas used by children during this inspection. 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. Page 1

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

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: KASHNANYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494148
	VISIT DATE: 10/11/2024

NARRATIVE

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Children play in the back yard. The outdoor play area was inspected. LPA observed the yard to be clean, free of debris, and fully fenced. Children's outdoor play equipment and toys are age appropriate and in good repair. LPA observed the yard to be fully fenced. At the end of the yard, a locked shed was observed, and licensee confirmed the shed remains locked during hours of operation

The Fire Extinguisher (3A-40-BC) is mounted on the wall in the kitchen (purchased on 10/03/2024). There is a working smoke/carbon monoxide detectors located in the child care room. The First Aid kit was observed and complete. LPA observed tables, chairs and napping equipment (including two play yards and 14 cots). Licensee reports she has no firearms or weapons in the home. LPA observed Licensee's and assistant's current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 02/2025). LPA also observed Licensee's and assistant's current Mandated Reporter AB1207 training (completed on 10/02/2024 and 10/03/2024).

The bathroom and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care. The fire drills are done every month. Last drill was conducted on 10/02/2024. 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/bedroom 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. 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, LIC702, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card. Page 2

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

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: KASHNANYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494148
	VISIT DATE: 10/11/2024

NARRATIVE

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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.
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.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

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: KASHNANYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494148
	VISIT DATE: 10/11/2024

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 Anna Kashnanyan informed 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 Anna Kashnanyan.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC809 (FAS) - (06/04)

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