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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019987
Report Date: 06/19/2024
Date Signed: 08/21/2024 08:38:47 AM

Document Has Been Signed on 08/21/2024 08:38 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SEROBYAN FAMILY CHILD CAREFACILITY NUMBER:
198019987
ADMINISTRATOR/
DIRECTOR:
LILIT SEROBYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 818-1109
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
06/19/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Lilit Serobyan - LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 9:20am, LPA met with licensee, Lilit Serobyan. Also present during this inspection, Licensee’s spouse. The licensee states that they currently has 4 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 7:30am-5:30pm, Monday-Friday.

This is a one-story home which consists of 4 bedrooms, 3 bathrooms, two kitchens, front room, back living room (day care area), front yard, side yard, and detached Additional Dwelling Unit (ADU). The children use two bedrooms (nap), back living room, bathroom attached to back living room, and driveway/back yard. Per licensee, areas off limits to children and parents include: front room, three bedrooms, 2 bathrooms, both kitchens, side yard, front yard, and ADU. All areas identified on the facility sketch were inspected. The licensee provides food for children in care where applicable.

The licensee states that 3 adults and 3 minors currently live in the home. Persons living in the home are identified on the attached LIC811. Licensee states that they currently have one assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no bodies of water on the premises. LPA reviewed storage of firearm in off limit area of the home, and is in accordance with Title 22. Additional information on attached LIC812.

At 9:35am, LPA was led on a tour of the facility by the licensee. Children enrolled are dropped off down the drive way to a side door that leads directly into the day care room. Upon entry in to the home, the back living room (day care room) was reviewed. LPA observed 2 infants present .There are age appropriate toys and equipment present at the facility. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. Smoke and carbon monoxide detectors were tested and are operable. High chairs were observed to be placed in the corner of the room. Per licensee, high chairs are used for meal time or snack time. There is a kitchen connected to the day care room that has child safety gates to prevent access from children in care. There are first aid supplies available.


REPORT CONTINUES PAGE 1 of 4
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SEROBYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019987
VISIT DATE: 06/19/2024
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At 9:50am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 10/27/2023, as indicated on receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

Next to the living room is the bathroom available for children in care. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. At this time, no children in enrolled are using the bathroom.

The next room reviewed was the bedroom next to the bathroom, which is used as a nap room for children in care. There are two cribs and a small bed available for children in care to use. There is a changing table available for use. There is a door in the nap room that leads to another bedroom. There is a another crib and larger bed present. Per licensee, this second bedroom will be used as an area for an ill child until an authorized representative comes to pick up child.

The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. Licensee states both a cell phone and a landline are used in the home.

At 10:10am, LPA observed the driveway and back yard area. The outdoor play area was observed to be fenced. At this time, children are using the driveway to the back yard for outdoor play time. There are small slides and play equipment for children in care to use. Licensee states, since the enrolled children are infants, they do not come out side too much at this time. The licensee is observed to be operating within the license capacity limitations.

At 10:20am, facility records were reviewed. The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 11/2025. Licensee has completed mandated reporter training that expires 10/27/2025. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

The following was discussed:


-There is one small puppy German shepherd that lives in the back ADU. It remains away from children
-Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home. REPORT CONTINUES PAGE 2 of 4
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SEROBYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019987
VISIT DATE: 06/19/2024
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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

Licensee does care for infants. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

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 confirmed that there are no Registered Sex Offenders living in the facility and LPA complete the RSO profile in FAS.

REPORT CONTINUES PAGE 3 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SEROBYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019987
VISIT DATE: 06/19/2024
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At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

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

Exit interview conducted and report was reviewed with the licensee Lilit Serobyan, at 12pm. Copy of the report was provided.



END OF REPORT PAGE 4 of 4
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4