Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413310
Report Date: 05/21/2015 12:00:00 AM
Date Signed: 05/21/2015 12:04:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:ASATRYAN FAMILY CHILD CAREFACILITY NUMBER:
197413310
ADMINISTRATOR:ASATRYAN, VARDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 509-8857
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:14CENSUS: 8DATE:
05/21/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Vardui AsatryanTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst's (LPA), Michelle Escandon conducted an Annual/Random visit at the above facility. LPA met with Licensee Vardui Asatryan who guided LPA on a tour of the single family home.
Present during the visit were the licensee, adult daughter, assistant and 8 children in care. Family members residing in the home include the licensee, spouse and adult daughter. All adults living/ working in the facility obtain a Criminal Background clearance and are associated to the facility.

The home consist 4 bedrooms 2 bathrooms, dining/living room, family room & kitchen. Per the licensee there is no bodies of water on the property. Three of the bedrooms are off-limits to children in care. The Licensee utilizes backroom as the primary area of care and one of the 3 bedrooms is utilized for napping.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation.Children's bathroom was observed to be free of toxic items, poisons, cleaning compounds, medicines, and hazardous items that can pose a danger to children in care. Kitchen , dining/living room are also off-limits to children in care. Parents/Guardians drop-off children thru the back entrance of the home.
Per licensee, there are no weapons or firearms of any kind in the facility at this time. LPA's did not observe any weapons. There are age appropriate toys and napping equipment on the premises. LPA observed fire extinguisher and smoke detectors to be in operable condition. LPA's observed Pediatric CPR/First Aid valid until 03/2016. The home does not have a fireplace.

Licensee documents all fire/earthquake drills conducted.


SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Michelle EscandonTELEPHONE: 310-337-4358
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2015
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: ASATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197413310
VISIT DATE: 05/21/2015
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Licensee has required postings, Emergency Disaster plan and Parents Rights Poster. Licensee has a small dog on the property. Licensee keeps the dog in an off limits area while children are in care. The back yard was inspected, area is enclosed. Outdoor child appropriate toys were observed and found to be in good condition. Backyard area does have an off-limit area which is fenced off. LPA observed a rear dwelling which is utilized as a guest house. The Licensee stated her son occupies the guest home only during major holidays.

A random sample of children's records were reviewed and found to be complete. Facility roster was also reviewed and found to be current.

The following was discussed with the licensee:


Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care on-line at www.ccld.ca.gov . Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
Requirements for fingerprint clearances and associations were discussed with the licensee.
Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1st offense and up to $3000.00 for the 2nd offense within a 12 month period, PER PERSON.

Per Tittle 22 Regulations, Licensee is found to be in compliance. An exit interview was conducted, a copy of this report was provided on this date.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Michelle EscandonTELEPHONE: 310-337-4358
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2015
LIC809 (FAS) - (06/04)
Page: 2 of 2