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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495049
Report Date: 11/16/2023
Date Signed: 11/16/2023 05:14:13 PM

Document Has Been Signed on 11/16/2023 05:14 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:SAROYAN FAMILY CHILD CAREFACILITY NUMBER:
197495049
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
11/16/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Gayane SaroyanTIME COMPLETED:
03:30 PM
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On 11/16/2023 Licensing Program Analyst (LPA) V. Wheatley conducted an announced inspection with licensee Gayane Saroyan for the purpose of a pre-licensing for a new license 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 applicant is requesting an increase in capacity. The licensee's adult daughter Margarita Mnatsakanyan was also present to help with translation.

The licensee is applying for a large family child care license with a maximum capacity of 14. The licensee received a fire department clearance from the Los Angeles City Fire Department.

Per the application, currently, the ages the applicant wishes to provide services for children birth to 13 years old with the hours of 7am to 5:00pm, Monday through Friday. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.

The home is four bedroom and two bathroom house. However the only the fourth bedroom which was the master bedroom is being used for the child care. LPA observed the child care to be clean, orderly and well ventilated. The home has central heating and air conditioning. All bedrooms are off limits. LPA inspected the bathroom in the children's room which will be used by day care children. It originally had a jacuzzi bathtub but however there are shelves built on top for storage of children's items. The kitchen is off-limits. LPA observed napping cots and playpens. LPA observed several toys which is age appropriate equipment. LPA observed a first aid kit and electrical outlets inaccessible. The applicant understands the children must be supervised at all times.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: SAROYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495049
VISIT DATE: 11/16/2023
NARRATIVE
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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: SAROYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495049
VISIT DATE: 11/16/2023
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LPA discuss food preparation with licensee. She states she cook the children's food the night before in the kitchen and then brings the food to the day care for the children to eat. There is a microwave to heat the food. LPA observed the fire extinguisher, carbon monoxide detector and smoke detector. which are all working properly. CPR/first aid expires 1/2024 and Mandated Reporter Training expires 1/2024. LPA observed a current children's roster. LPA reviewed children's records which are complete.

According to the applicant, there no firearms and no bodies of water. LPA did not observe any bodies of water on the premises. The backyard is large, clean and safe. LPA observed several age appropriate toys. Licensee states there is a small dog on the premises and is kept inside of the main home, off limits to children.

Exit interview conducted, and report was reviewed with the applicant. A copy of the report will be provided to applicant.

License issuance will be determined by the department unit licensing manager.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SAROYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495049
VISIT DATE: 11/16/2023
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Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Keep in Your Family Child Care.

FORMS TO BE POSTED


LIC203 Facility License
LIC 610A Emergency Disaster Plan
LIC 9148 Earthquake Preparedness Checklist
PUB394 Notification of Parents Rights Poster
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
LIC 9166 Consent/Verification for Nebulizer Care
CDPH 286 (Immunization Blue Card) with Immunization record
PUB 72- Family Child Care Consumer Guide
LIC 995A Notification of Parent’s Rights
LIC 995E Caregiver Background Check Process
LIC 9212 Family Child Care Consumer Awareness Information
PM 286 California School Immunization Record (blue card)-http://www.dhs.ca.gov/publications/forms/immunization.htm
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 9151 Property Owner/Landlord Notification Form
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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