Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413310
Report Date: 11/09/2016
Date Signed: 11/09/2016 01:20:42 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: 9DATE:
11/09/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Vardui AsatryanTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit. LPA met with the licensee and toured the home inside and outside. The licensee was present with 9 children and an assistant (associated to the facility). This is a single story 4 bedroom, 2 bathroom home with kitchen, living room, dining room and a den used as a playroom. There is also a small room ( adjacent to the playroom) where children nap and there is a detached garage with a recreation room attached to the garage at the rear right side of the home. There is a large patio area at the rear of the home. The patio is enclosed by a low fence and is off-limits to children. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include the licensee, her husband, and her daughter. Licensee has an operating smoke detectors in the child care room as well as an operating and fully charged Fire Extinguisher. Licensee reports she has no firearms or weapons in the home. The home did not have carbon monoxide detector during this visit. Licensee was unable to demonstrate current proof of CPR/First Aid Certificates (expired 03/2016).
The home was found to be clean and orderly with proper ventilation for safety and comfort. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. The kitchen cabinets and drawers were inspected for inaccessibility of toxins/chemicals, knives and other sharp objects which may be harmful to children in care.
LPA observed toys and furniture that were age appropriate and in good repair.
LPA observed the fire drill log. The fire drills are done every month.
LPA toured the back yard and found it to be fully fenced. Outdoor play area was inspected and observed to be free of hazards. Licensee has a canopy providing shade over the play equipment and the doors to the garage and recreational room are kept locked whenever children are in care.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2016
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
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: ASATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197413310
VISIT DATE: 11/09/2016
NARRATIVE
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New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

Update on Incidental Medical Services: Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag. Please see Child Care Quarterly Report on www.ccld.ca.gov

Exit interview was conducted and a copy of the report was provided.

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2016
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
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: ASATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197413310
VISIT DATE: 11/09/2016
NARRATIVE
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Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , Child Care Facility Roster (LIC9040), Emergency Disaster Plan (LIC610a).

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.

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2016
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
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: ASATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197413310
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/23/2016
Section Cited
H & S 1596.954
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HEALTH AND SAFETY - Carbon monoxide detectors required; inspection
Every licensed family day care is required to have one or more carbon monoxide detectors in the home that meet the standards established. The home did not have carbon monoxide during this visit.
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Licensee agrees to purchase a carbon monoxide and install it at the facility by November 23, 2016.
Licensee will provide the department with proof of purchase and placement of detector by photo.
Type B
11/23/2016
Section Cited
102416(c)
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Licensee is required to maintain current Pediatric CPR and First Aid certifications at all times..
Licensee was unable to demonstrate current proof of CPR/First Aid Certificates
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Licensee will provide proof of current Pediatric CPR & Pediatric First Aid certifications or registration for by 11/23/2016
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2016
LIC809 (FAS) - (06/04)
Page: 4 of 4