197494835-7-13-2021-30-CC-LPHS-C4VRGA-20210713130025

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494835
Report Date: 07/13/2021
Date Signed: 07/13/2021 01:00:48 PM

Document Has Been Signed on 07/13/2021 01:00 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:	ASATRYAN FAMILY CHILD CARE		FACILITY NUMBER:	197494835
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/13/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	OFELYA ASATRYAN AND PAUL OUZOUNIAN		TIME COMPLETED:	01:15 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	On 7/13/2021 at 9:30 AM Licensing Program Analyst (LPA) Loyce Phillips conducted an announced Pre-Licensing inspection with Ofelya Asatryan and Paul Ouzounian. This inspection is due to an application received for a small family childcare license. The applicants guided LPA on a tour of the facility and intends to operate Monday through Friday 8:30 AM to 4:30 PM. Present during today's inspection is both applicants and Individual #1 and child #1 who reside in the home. Areas identified on the facility sketch were inspected. This is a two-story home with four bedrooms and four bathrooms. The home has central air and heat and a fireplace in the living room. Residing in the home is both applicants, Individual #1, and Child #1, see LIC812 for details. Applicants intends to provide snacks and meals for day care children. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children. LPA observed age appropriate safe toys. The applicants advised, children will nap on cots in the sleeping area which is bedroom #2 located next to attached garage. The home was inspected as follows: Living room, family room, kitchen, laundry area (downstairs), four bedrooms (2 downstairs and 2 upstairs), four bathrooms (3 downstairs and 1 upstairs), kitchenette and three car attached garage. The attached garage has been converted into daily activity space for children in care. Applicants are fully aware that children may not eat nor sleep in the converted garage. The garage is properly ventilated with an air conditioning unit with heat. Areas that are inaccessible to children are as follows: The entire main home, which consist of living room, kitchen, laundry area, family room, master bedroom #1, bathrooms #1, #4, #3 and bedrooms #3 and #4 (upstairs). The backyard is off limits. The backyard has a fountain which is completely empty of water.

Peter Flores	TELEPHONE:
Loyce Phillips	TELEPHONE:
	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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: ASATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494835
	VISIT DATE: 07/13/2021

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Areas that are accessible to children are as follows: attached converted garage (daily activity room), bedroom #2 (for sleeping and eating), kitchenette adjacent to bedroom #2 and bathroom #2 located next to the kitchenette. The children will play in the front yard area.

Applicants has a smoke detector in bedroom #2, tested and operating. No medications were observed in the home. Cleaning products are kept in the laundry area and off-limits.

Facility Administration: Pediatric First Aid and CPR expires 4/28/2023 for applicant, immunization's are on file.

The following was discussed with the applicants:
• Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. If the is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week.
• In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
• Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The family day care home shall maintain documentation of the required immunization's or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
• A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
• Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated.
• The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, batteries should be replaced.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE:
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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: ASATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494835
	VISIT DATE: 07/13/2021

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• Changes should be reported the to the Department as soon as they occur such as construction and remodeling.
• Telephone number changes and/or if you move from home.
• Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
• Fire and safety drills must be performed every six months and documented for review by the Department.
• There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
• Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
• Saucer chairs, bouncers, walkers, or any similar items are prohibited.
• All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
• Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
• LPA provided and advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The applicants was informed of the Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email: childcareadvocatesprogram@dss.ca.gov

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com
Applicant completed this training on 4/29/2021.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE:
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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: ASATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494835
	VISIT DATE: 07/13/2021

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Update on Incidental Medical Services (IMS):
Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department.

IMS Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.
Incidental Medical Services (IMS) policy was discussed. For further IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm
Currently, the facility does not provide Incidental Medical Services - IMS.

SIDS & SHAKEN BABY SYNDROME INFORMATION discussed.
Safe Sleep Practices were discussed with the applicant. When putting infants down to nap or long periods of sleep, children must be placed on their backs, in a crib, on a firm mattress with nothing in the crib except for a fitted sheet over the mattress. The child must be physically monitored and documented every 15 minutes, check their temperature, color of skin, and breath.

LPA discussed with applicants the process of childcare during a pandemic: facial coverings in day care, social distancing, hand washing hygiene, postings, and cleaning and disinfecting of surfaces and high traffic areas. Children should follow social distancing when indoors. LPA discussed isolation area with applicant when children are sick, children to be placed in the activity room while parents arrive. LPA discussed the importance and process of health screenings for children upon arrival to the facility. LPA also provided resources and materials as well as links for COVID-19 to assist the provider. The Guidance for Early Childhood Education was shared with the applicant along with postings regarding COVID-19. LPA also discussed the proper way to clean and disinfect items used daily throughout the day care, by submerging toys in or spraying with disinfectant and allowing sufficient contact time prior to wiping down.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE:
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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: ASATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494835
	VISIT DATE: 07/13/2021

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Children’s records requirements:
• LIC 700 Identification and Emergency Information
• LIC 627 Consent for Emergency Medical Treatment
• LIC 282 Affidavit Regarding Liability Insurance
• LIC 9150 Parent Notification Additional Children in Care
• Immunization record
• LIC 995A Notification of Parent’s Rights

FACILITY RECORDS:
• LIC 624B Unusual Incident/Injury Report
• LIC 9040 Child Care Facility Roster
• LIC 9052 Employee Rights,
• LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
• LIC 9149 Property Owner/Landlord Consent Form
• LIC 9151 Property Owner/Landlord Notification Form
• Proof of current pediatric CPR and First Aid Certificates
• Copy of your deed or lease/rental agreement
• Documentation of Fire and Disaster drills
• Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
• Mandated Reporter certificate – www.mandatedreporterca.com – must be renewed every two (2) years

FORMS TO BE POSTED
• LIC203 Facility License
• LIC 610A Emergency Disaster Plan
• LIC 9148 Earthquake Preparedness Checklist
• PUB394 Notification of Parents Rights Poster

A complete packet that includes the documents listed above, as well as a ratio flyer, Effects of Lead exposure, PIN 19-02 on Safe Sleep, PIN 19-18 Emergency Disaster, Never Shake a Baby flyer, were discussed with the applicant during this inspection.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE:
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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: ASATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494835
	VISIT DATE: 07/13/2021

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Based on today's inspection the following corrections are required prior to issuing a license:
· Install working carbon monoxide
· Install Fire Extinguisher (2A10BC)
· Install front gate that leads into the driveway (front yard area)

LPA Phillips advised applicant that no napping and/or eating is to take place in the converted garage unless a permit is provided to the Department. Applicants understood and agreed.

Proof of corrections is to be provided to the Department by 7/30/2021.

An exit interview was conducted and a copy of this report was provided to applicants Ofelya Asatryan and Paul Ouzounian on this date.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE:
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE:
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

LIC809 (FAS) - (06/04)

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