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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494336
Report Date: 10/06/2021
Date Signed: 10/06/2021 02:49:23 PM

Document Has Been Signed on 10/06/2021 02:49 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SHAHBAZYAN FAMILY CHILD CAREFACILITY NUMBER:
197494336
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
10/06/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Heghine Shahbazyan TIME COMPLETED:
03:00 PM
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On 10/6/2021, Licensing Program Analyst (LPA) Dalicia Adkins conducted an announced case management. LPA Adkins met with licensee, Heghine Shahbazyan who guided LPA Adkins on a tour of the facility. Six children were present, no other adults present in the home. Operation days and hours Monday- Saturday 7:00am- 10:00pm.

The purpose of today’s inspection is to inspect home for an increase of capacity. Licensee currently operate a small family child care with 8 children and is requesting to increase to large family child care home to care for up to 14 children. Fire Clearance granted for up to 14 children, dated 7/8/2021. Licensee was granted small family day care licensee, effective date 10/1/2019.

LPA inspected the entire facility including outside play area.
This is a single family, single story home with 3 bedrooms and 2 bathrooms. Bedrooms 1 and 2 located in the main living area will be off limits. Bathroom in the main living area is off limits and is made inaccessible by locked door. Kitchen is off limits and made inaccessible by locked door that separates the kitchen from the room utilized to care for children, stove knobs are covered with child proof covers and cabinets are made inaccessible with child safety locks.

LPA observed required posting: facility license (LIC 203), Emergency disaster plan (LIC 610A) Earthquake Preparedness Checklist (LIC 9148) Notification of Parents right (PUB 394).

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SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2021
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHAHBAZYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494336
VISIT DATE: 10/06/2021
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LPA Adkins reviewed children and licensee files. Licensee has current Pediatric CPR -Pediatric First Aid certificates, expires on 08/2023 and mandated reporting completed on 9/5/2021. LPA Adkins observed First Aid Kit stored in kitchen cabinet.

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.

Day care will be conducted in the Room A; located in the rear of the home which has a restroom that will be utilized for day care children. Children will nap in room B. Applicant also plans to use a detached garage for activities and instructions. Applicant was informed that there shall be no eating or sleeping in this area. There is a pool on the property that has been segregated from the home and is being utilized by a neighboring home that is owned by the licensee. There is a gate on the side of the home that leads to the pool that shall remain locked at all times, there is no access to the pool within the day care home; no windows or indoor entries. The fireplace located in the main living room is made inaccessible by a glass door and will not be in use during day-care hours.

Per Licensee there are no weapons or firearms on premises. LPA Adkins observed the home to be ventilated, working heating system and working telephone. Cleaning compounds, medicines and sharps are inaccessible to children. Fire extinguisher located in room A, serviced on 7/13/2021. Carbon monoxide detector and smoke detector located in the primary care room A, mounted to the ceiling near room A door entrance. LPA observed 14 available cots for napping. There are no infant currently in care. Licensee was advised to have available crib for each infant before caring for infants. Cots are stored in closet in room B, next to primary care room A. Children will nap in room B and children will utilize bathroom in room A. LPA observed one operable toilet and sink. Individual storage for children is located in room A.

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SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHAHBAZYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494336
VISIT DATE: 10/06/2021
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All meals including snacks will be provided by licensee, parents are responsible for brining diapers. LPA Adkins observed available drinking water.

Backyard is enclosed with fencing and locked door. Parents will enter the backyard door to drop off children. LPA observed age appropriate play equipment/toys and is in good repair.

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

Incidental Medical Services (IMS) policy was discussed. 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/childqanda.htm

Child Care Licensing Program has strengthen regulations around safe sleep. The new requirements are consistent with the American Academy of Pediatrics safe sleep guidelines, and CCLP seeks to connect licensed care facilities with the regulations and resources to improve environments that could otherwise put infants at undue risk. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep website at http://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 http://www.cpsc.gov/ and recommended they register all infants devices with the CPSC to be notified of any recalls on their purchased equipment.

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SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHAHBAZYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494336
VISIT DATE: 10/06/2021
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LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Licensee Heghine Shahbazyan was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.



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

Exit interview conducted and report was reviewed with licensee Heghine Shahbazyan.




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SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC809 (FAS) - (06/04)
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