197495036-6-23-2023-58-CC-SGAN-CT3R34-20230623123920

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495036
Report Date: 06/23/2023
Date Signed: 06/23/2023 12:39:30 PM

Document Has Been Signed on 06/23/2023 12:39 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:	KARAPETYAN FAMILY CHILD CARE		FACILITY NUMBER:	197495036
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 6	CENSUS: 6	DATE:	06/23/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Aykui Karapetyan, Licensee		TIME COMPLETED:	12:45 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	Case Management Visit Conducted In Armenian On 06/23/2023 at 09:00 AM Licensing Program Analyst (LPA) Silva Garibyan conducted an unannounced visit for the purpose of an increase of capacity inspection for 12717 Street, North Hollywood, CA 91605. The purpose of this increase of capacity 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 April of 2022. 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 06/02/2023 by LA City Fire Prevention Bureau (inspector Shawn Connolly). Present during today's inspection were Licensee, two assistants, and six children (including one infant). There is no pool, spa or other bodies of water on the premises. Family members residing in the home include the applicant and applicant's friend. Per the applicant there is a firearm/ammunition in the home. The weapon is a hand gun. The firearm is in a separate locked case and the ammunition are in a separate locked container. Living room has a fireplace, which has been screened to prevent access by children. Control of property verified with Mortgage Statement and is on file. Licensee has submitted a disaster plan. Page 1 of 5

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

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: KARAPETYAN FAMILY CHILD CARE	FACILITY NUMBER: 197495036
	VISIT DATE: 06/23/2023

NARRATIVE

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The licensee has completed preventive health and safety/Childhood Nutrition/ Lead Exposure Prevention and Mandated Reporter training ( completed on 03/30/22). The licensee has current pediatric CPR/First Aid training completed in March of 2022. Hours of operation for the facility are Monday- Saturday from 7:30 AM to 6:00 PM and will be closed all major holidays. Ages served are new born - School age.

This is a single story dwelling with three bedrooms, four bathroom, kitchen , living/dining room, play room, attached garage, and storage room in the back yard. The home was inspected inside and out for safety, comfort, cleanliness, telephone service (cell phone operating at all times), heating and ventilation. Poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children are kept in the garage made inaccessible by a locked door.

On limits: Play room, bedroom adjacent to the play room, bathroom in the hallway, bathroom in the bedroom/nap room, bathroom in the patio. Children will be provided with meals and snack in the play room. The bathrooms were inspected (one operable toilet, sink in each bathroom and no immediate or potential hazards). LPA observed latches on all cabinets and drawers. Sharp items are kept in the latched drawer. Children nap in the bedroom adjacent to the play room. The bedroom was inspected and no immediate hazards observed. LPA observed cots and a play pen in the bedroom.

Off Limits: Two bedrooms (#2 and #3) and bathroom #3.

The outdoor area/back yard is fenced in. Licensee is stating that when children are having outside time she will ensure 100% supervision and never leave children unattended. LPA observed a storage room and one shed in the back yard. The shed and the storage room were observed to be locked. Page 2 of 5

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

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: KARAPETYAN FAMILY CHILD CARE	FACILITY NUMBER: 197495036
	VISIT DATE: 06/23/2023

NARRATIVE

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Licensee has the required documents posted in the FCCH: 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.
LPA reviewed assistant's and children's files.

The home was found to be clean and orderly with proper ventilation for safety and comfort. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. The Fire Extinguisher (2-A:10-B:C) is mounted on the wall in the covered patio. There is a working smoke/Carbon Monoxide detectors located in all rooms. The licensee has installed the pull fire alarm that is required for large Family Child Care Homes.

LPA observed toys and furniture that were age appropriate and in good repair. LPA toured the backyard and found it to be fully fenced. Children's outdoor play equipment and toys are age appropriate and in good repair.

Licensee was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

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: KARAPETYAN FAMILY CHILD CARE	FACILITY NUMBER: 197495036
	VISIT DATE: 06/23/2023

NARRATIVE

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Shaken Baby Syndrome Awareness & SIDS. Applicant was reminded never shake a baby to prevent Shaken Baby Syndrome. LPA discussed Safe Sleep Regulations with Applicant: 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; 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. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Applicant was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.
Mandated Reporter Required. Licensee was made aware of AB 1207, commencing January 1, 2018, 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 Health & Safety Code 1596.8662.

Criminal Record Clearance. All adults who reside or work in the home must obtain a criminal record clearance or exemption.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

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: KARAPETYAN FAMILY CHILD CARE	FACILITY NUMBER: 197495036
	VISIT DATE: 06/23/2023

NARRATIVE

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Licensing Reports Given to Parents Required. Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility. Assembly Bill 633.
The licensee may find additional information and forms on the Department’s website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.
To receive important license related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

No Deficiencies are being cited on this date.
Capacity increase is pending managerial review.

An exit interview was conducted and a copy of the report was provided.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

LIC809 (FAS) - (06/04)

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