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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495122
Report Date: 06/09/2022
Date Signed: 06/09/2022 09:34:24 AM

Document Has Been Signed on 06/09/2022 09:34 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:TADEVOSYAN FAMILY CHILD CAREFACILITY NUMBER:
197495122
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
06/09/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
07:00 AM
MET WITH:Zaruhi Tadevosyan, ApplicantTIME COMPLETED:
10:00 AM
NARRATIVE
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On 06/09/2022 at 7:00 AM Licensing Program Analyst (LPA) Silva Garibyan conducted an announced visit for the purpose of a Pre-licensing inspection with Zaruhi Tadevosyan, applicants. Applicant was informed that we are going to tour the home for a pre-licensing requirement per title 22 regulations and health and safety standard code requirements. Hours of operation for the facility will be 6:00 AM- 10:00 PM Monday- Sunday and will be closed all major holidays. Ages served are new born - School age. Applicants have submitted a disaster plan. The applicants have completed preventive health and safety/Childhood Nutrition/ Lead Exposure Prevention and Mandated Reporter training ( completed on 03/21/22). The applicant has current pediatric CPR/First Aid training that will expire in April of 2024. Family members residing in the home include the applicant, spouse, and applicant's adult son. There is no pool, spa or other bodies of water on the premises. Play room has a fireplace, which has been screened to prevent access by children. Interior: This is a single story dwelling with four bedrooms, three bathrooms, 2 kitchen , living room/dining room, family room/Play room, detached garage, car port ( accessible from Cantara Street).

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.

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SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2022
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: TADEVOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495122
VISIT DATE: 06/09/2022
NARRATIVE
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On limits: The Family/Play room, the bathroom in the hall way, applicant's son's bedroom (Bedroom #1), kitchen adjacent to the Play room. Children will eat and sleep in the Play room and in applicant's son's bedroom. Children will be provided with meals and snack in the main care area. The bathroom was inspected. LPA observed adequate supply of soap and poster guidance of effective hand washing procedures during COVID-19 provided next to sink. 1 operable toilet, sink and no immediate or potential hazards.

Off Limits: Bedroom #2, Bedroom #3, and Bedroom #4, the bathroom in Bedroom #4, the bathroom/laundry room in the back, the kitchen adjacent to the living/dining room, and the detached garage. LPA observed latches on all cabinets and drawers. Sharp items are kept in the latched drawer. Bedrooms all inspected and no immediate hazards observed.

The outdoor side yard is fenced in. Licensee is stating that when children are having outside time she will ensure 100% supervision and never leave children unattended.

Licensee was provided a Self-Assessment guide to follow in response to COVID-19 and was also informed that during today’s inspection that Licensing Program Analyst, Gutierrez provided Technical Assistance in response to reducing the spread of COVID-19. Applicant was informed to follow CDC guidelines and stay up to date with the Provider Information Notices while using best practices during the COVID-19 Pandemic.

Fire extinguisher (2A-10-BC) is located in the kitchen. Applicant has an operable Smoke/Carbon Monoxide detector located in the Play room. An accessible First Aid Kit equipped with, cleansing pads healing ointment, bandages, gauze, and a digital thermometer in closet of entrance of home.

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SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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: TADEVOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495122
VISIT DATE: 06/09/2022
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Facility Administration: Licensee completed training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. Pediatric A certificate of completion of a course or courses in preventive health practices as defined in s subdivision (a) or certified copies of transcripts that identify the number of hours and the specific course or courses taken for training. (8 hours required) Preventative Health and Safety practices including childhood nutrition/Lead Exposure Prevention are completed and placed in facility file.

Licensee was reminded that all adults 18 and over living in the home, persons who provide 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 licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with [applicant, 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 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: Karren Starks
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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: TADEVOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495122
VISIT DATE: 06/09/2022
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APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:

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: http://www.ada.gov/childqanda.htm



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

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.

Exit interview conducted and report was reviewed with the Applicant, Zaruhi Tadevosyan.

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SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC809 (FAS) - (06/04)
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