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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495072
Report Date: 04/26/2024
Date Signed: 04/26/2024 11:00:08 AM

Document Has Been Signed on 04/26/2024 11:00 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SARGSYAN FAMILY CHILD CAREFACILITY NUMBER:
197495072
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
04/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:30 AM
MET WITH:Hermine Sargsyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Annual Visit Conducted In Armenian

On 04/26/2024 Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit. The purpose of this 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 licensee was present with four children. 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 04/10/2024 by LA City Fire Prevention Bureau (inspector Elton Mashack). The licensee has installed the pull fire alarm that is required for large Family Child Care Homes Hours of operation for the facility will be 7:00 AM- 6:00 PM Monday- Friday and will be closed all major holidays. Ages served are new born - 15 years old. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include the licensee and licensee's minor daughter. This is a single story dwelling with two bedrooms, one bathroom, kitchen, living/dining room. This is the back house on the property. The front unit on the property has different address and occupied by the owners (the address for the front unit: 6048 Denny Ave, North Hollywood, CA 91606).


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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495072
VISIT DATE: 04/26/2024
NARRATIVE
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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 latched cabinets inaccessible during operating hours. Children eat and sleep in the living/dining room. Bedroom(2) is used for napping.
The home was observed to have an enclosed back yard. The side gate was observed to be locked and a ring door bell installed. LPA toured the backyard and found it to be fully fenced. LPA observed one storage shed in the back yard. The shed was observed to be locked.
LPA observed by the entrance the Parent Board with all necessary posting required ( 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, Effects of Lead Exposure poster). Child Care Facility Roster (LIC9040) was on file.

A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card, and sleep log.

The living room and dining room area were observed to have age appropriate toys. Two children size table and 16 chairs were observed in the living room. Nine beds, six cots, and one crib were observed in Bedroom (2).
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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495072
VISIT DATE: 04/26/2024
NARRATIVE
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LPA observed licensee test the carbon monoxide and smoke detector in the hall way. The Fire Extinguisher (2-A:10-B:C, Inspection Date: 03/06/2024) is mounted on the wall in the living room. All electrical outlets were observed to be covered. Smoke/Carbon Monoxide detectors are located in all rooms. Per licensee, there are no weapons or firearms of any kind in the facility at this time. LPA did not observe any weapons.
The bathroom that children use is located in the hall way. LPA observed one toilet, one sink, and one shower in the bathroom. LPA observed a shower free of shampoos and soaps. The bathroom was observed to be free of hazards. Under the sink cabinet was observed to have a safety latch making the contents inaccessible to the children in care.
The kitchen was observed and inspected. All lower cabinets were inspected and observed to have safety latches, making the contents inaccessible to the children in care. Under the sink cabinet was observed to have cleaning supplies and LPA observed a safety latch, making the content inaccessible. All knives and sharp objects are stored in a drawer that was observed to have a safety latch making the items inaccessible. Licensee provides meals and snacks. LPA discuss food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date.
The licensee has completed Mandated Reporter training ( completed in April of 2024). The licensee has current pediatric CPR/First Aid training completed in February of 2024. LPA observed the fire drill log. The fire drills are done every month. Because the licensee rents the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Page 3 of 5
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495072
VISIT DATE: 04/26/2024
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 licensee [or facility representative] 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.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495072
VISIT DATE: 04/26/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee Hermine Sargsyan, confirmed that there are no Registered Sex Offenders living in the facility. RSO profile in FAS was completed on 04/26/2024.

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

Exit interview conducted and report was reviewed with the licensee Hermine Sargsyan.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC809 (FAS) - (06/04)
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