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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495055
Report Date: 06/28/2022
Date Signed: 07/07/2022 08:16:25 AM

Document Has Been Signed on 07/07/2022 08:16 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:KAZARYAN FAMILY CHILD CAREFACILITY NUMBER:
197495055
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
06/28/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Anna Kazaryan TIME COMPLETED:
11:30 PM
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On 6/28/2022 Licensing Program Analyst (LPA) Judy Laureano and Licensing Program Manager(LPM) Claudia Escobedo conducted an announced inspection with applicant Anna Kazaryan the purpose of a pre licensing inspection of 13406 Friar Street, Van Nuys, CA 91401. The purpose of this inspection 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 licensee is applying for a Small Family Child Care Home license for a max capacity of 8. Per the application, at this time, the ages the applicant wishes to provide services for, are children from birth to 12 years old with the hours of 7 am to 7 p.m. Monday- Friday. Applicant is available for overnight care on a case by case basis.

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.
Copy of the property tax bill is on file reflecting Anna Kazaryan and Martin Khanjian have control of property. Currently living in the home is applicant with husband Martin Khanjian.

The home is a single family unit with 3 bedrooms with 1 full bathroom, living room, dining room, family room, kitchen and ½ bathroom. LPA observed a front yard that has been designated as off limits, a back yard with a pool and a detached garage. The pool area was observed to have a self latching fence that is at least five feet high. Fence does not obscure the pool from view, gate swings away from the pool and the bottom and sides of the fence comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building code.

Parents will access the home through the main entrance. Entering the home through the main entrance, you are led to the living room area that has been designated for the day care. Living room was observed to have age appropriate toys, a children’s rug and a variety of manipulative.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
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: KAZARYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495055
VISIT DATE: 06/28/2022
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LPA observed a mounted television under children's cubbies. LPA observed a couch in the space. Applicant confirmed that children will eat and nap in the area. LPA observed all electrical outlets were covered. A camera monitor was observed in the space and LPA discussed with applicant disclosing the use with potential families. Applicant confirmed the camera monitor will be use to ensure children are safe and monitor does not record footage.

Next to the living room LPA observed a hallway that leads to the bedrooms and bathroom in the home. LPA observed a carbon monoxide and smoke detector in the hallway. Bedroom 1 and bedroom 2 were observed and designated as OFF LIMITS to the children in care. Applicant confirmed that the doors will remain locked during the hours of operations.

Bedroom 3, designated as the Sleeping Room was observed next to the bathroom. LPA observed a small bed and two pack and plays. A carbon monoxide and smoke detector was observed in the space. A storage closet was observed and inspected. All electrical outlets will be covered. Applicant agrees to move the electrical wires and desk out of the space and the glass shelf.

The bathroom that children will use is located next to bedroom 3. A toilet, sink, cabinets, shower and tub were observed in the space. Under the sink cabinet was observed to have cleaning supplies and LPA observed cabinet to have a safety latch. Applicant agrees to remove all products from the bath tub area and secure it under the sink cabinet. LPA discussed COVID-19 recommendation such as using paper towels and displaying a handwashing sign for children to view.

The Family room was observed and designated as OFF LIMITS to the children in care. You are able to access the family room through the living room/day care room and the end of the hallway. Both doors were observed to have a lock and will remain lock to ensure the
area is OFF LIMITS to the children in care. LPA observed a fire place with a metal mesh gate barricading the area. Next to the family room, LPA observed the dining room area.
Both areas are OFF LIMITS to the children in care. The dining room was observed to have a sliding door that leads to the back yard. Applicant confirmed the door will not be used by the day care.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
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: KAZARYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495055
VISIT DATE: 06/28/2022
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Outside the dining room a small hallway way with closet/pantry style cabinets were observed. LPA informed applicant to add safety latched to all cabinets. A safety gate was recommended to be placed at the end of the hallway ensuring children are not able to access the dining room area.

The kitchen has been designated as OFF LIMITS to the children in care but will be used as a walkway to access the back yard. You are able to access the kitchen through the living room and the end of the dining room. Kitchen cabinets were observed and inspected. The stove, refrigerator, sink and counter space area were observed and inspected. Knifes and sharp objects observed to be made inaccessible to the children in care. Applicant confirmed that facility will be providing meals and snacks. LPA discuss food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date. As a COVID precautions, LPAs advised applicants to use disposable paper goods. LPA observed the working fire extinguisher mounted in the doorway between the kitchen and the living room area. Licensee agrees to add a safety latch to the cabinet near the stove and cabinet under the microwave.

A half bathroom was observed outside the hallway that leads to a side door. The ½ bathroom has been designated as OFF LIMITS to the children in care and applicant confirmed that door will remain locked during the hours of operations.
The backyard has been designated as the outdoor area. The door outside the ½ bath will be used to access the back yard. Children will walk through the kitchen and through the hallway to access the back yard. LPA observed an electrical metal gate that leads to the back yard. Applicant confirmed gate uses a timer and is control by a remote control kept inside the home. The area children will use for outdoor space was observed to be cemented. A shaded area was observed right outside the dining room area. LPA requested two safety gates around the outside kitchen/grill area to ensure children are kept safe while playing outside. Licensee stated that children will primarily use the cemented area located on the side of the home.

Licensing Program Manager left facility at approximately 9:50 a.m. and LPA Laureano continued with the inspection.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
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: KAZARYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495055
VISIT DATE: 06/28/2022
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The following areas are OFF LIMITS to the children in care:
1. Bedroom 1 and Bedroom 2- doors will remain closed during the hours of operations.
2. Family room and Dining room- door will remain locked during the hours of operations.
3. Kitchen area- only used for walkway to access the backyard
5. ½ bathroom- door will remain locked during hours of operations.
6. Back yard pool area and detached garage-

The following corrections are needed:
1. Parent board with necessary posting
2. Bedroom 3/napping room- electrical covers, removal of the desk with electrical wires, glass display shelf and long curtains in room.
3. Bathroom- remove shampoo and other products from tub area.
4. Kitchen- safety latch on pantry cabinet next to refrigerator, cabinet under microwave, knives moved to a higher shelf.
5. Pantry cabinets outside dining room- safety latch.
6. Safety gate added outside the dining room.
7. Safety gates added to the outside kitchen/grill area.
8. Remove the treadmill from the outside area and add a safety latch to the glass storage .

The above requirements shall be submitted by July 8th, 2022. Exit interview was conducted with applicant Anna Kazaryan. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
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: KAZARYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495055
VISIT DATE: 06/28/2022
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The following was discussed with the applicant:
Applicant was made aware 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 in order 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 Address: childcareadvocatesprogram@dss.ca.gov
Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.
Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, 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. Licensee was reminded of their responsibility to report suspected child abuse.


LPA reviewed with applicant Anna Kazaryan the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, family forms/records, and information to be posted.

Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.

Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation.



Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
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: KAZARYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495055
VISIT DATE: 06/28/2022
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LPA discussed the safe sleep regulations with applicant 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 applicant 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.

Incidental Medical Services (IMS) policy was discussed. For 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

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
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: KAZARYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495055
VISIT DATE: 06/28/2022
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· Applicant, was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed.
· 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. · 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. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)

· 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.

· Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference.

· Fire and safety drills must be performed every six months and documented for review by the Department.

· 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.

· LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

· 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. To receive important licensed-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.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
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