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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700077
Report Date: 05/19/2023
Date Signed: 05/19/2023 01:25:26 PM

Document Has Been Signed on 05/19/2023 01:25 PM - 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:KOTANJYAN FAMILY CHILD CAREFACILITY NUMBER:
195700077
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/19/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Anna KotanjyanTIME COMPLETED:
01:45 PM
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On 05/19/23, at 08:48 am, Licensing Program Manager (LPM) Emiko Bell and Licensing Program Analyst (LPA) Maria Rendon arrived at the facility, which is located at 19300 W. Covello Street, Reseda, CA 91335. LPM and LPA were greeted and let into the residence by Applicant Anna Kotanjyan, to whom the purpose of the inspection was announced. The purpose of the inspection was to conduct an announced pre-licensing inspection to ensure that the health, safety and personal rights, as required by Title 22 and Health and Safety Code governing California Child Care Homes, will be met.

Applicant is applying for a Small Family Child Care Home with a capacity of 08 children, ages 0 to 13 years old. Control of property was verified by a copy of a mortgage statement. Applicant’s proposed days and hours of operation are Monday – Friday 7:00 a.m. – 10:00 p.m. Currently living in the home are applicant and her husband.

Beginning at 08:50 am, applicant guided LPM and LPA on a tour of the residence and back yard. All areas identified on the facility sketches were inspected, including off-limit areas. This is a two-story home that consists of: (first floor) one bedroom labeled #1, one full bathroom labeled #1, a half bathroom, kitchen/dining room, living room, and attached garage, and (second floor) three bedrooms labeled #2, #3 and #4; three bathrooms labeled #2, #3, #4; and a walk-in closet in the hallway. Children in care will only use rooms located on the first floor, which are the living room, kitchen/dining room, bedroom #1, and the half bathroom, which is located between bedroom #1 and the stairs. The garage, bathroom #1 and all the rooms located on the second floor will be off limits. Home was observed with stairs, LPM and LPA observed the stairs to be barricaded downstairs and upstairs with the use of a child gate.

LPM and LPA observed a working carbon monoxide detector in the home located between the kitchen and living room. LPM and LPA were able to hear a successful test. Smoke detectors are located in bedroom #1, ceiling near 1/2 bathroom, and all bedrooms located upstairs and in the upstairs hallway and LPM and LPA were able to hear a successful test. Fire extinguisher 2-A-10-B:C was observed on the first floor, on the right

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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 5
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: KOTANJYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700077
VISIT DATE: 05/19/2023
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side of the entrance of the home. LPM and LPA requested to see the fire extinguisher and applicant had to reach high to be able to bring it down. Applicant stated that she will mount the fire extinguisher on the wall between the kitchen and living room. Electrical outlets were observed to be inaccessible to children in care with the use of plug covers. The home was observed to be clean and orderly with heating and ventilation. LPM and LPA observed safe toys, play equipment, and materials. LPM and LPA verified the home has a working cell phone number.

LPM and LPA advised that baby walkers, bouncer, johnny jumper, saucer chairs are not permitted.

LPM and LPA observed cleaning compounds and detergents in the garage, the door of which is rendered inaccessible to children by a doorknob handle cover. LPM and LPA advised that poisons shall be locked.

One play yard was observed for napping. LPM and LPA advised that there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. At the time of visit, applicant did not have any other napping equipment. LPM and LPA advised that the placement of cribs or play yards shall not hinder entrance or exit to and from the space where infants are sleeping. LPM and LPA advised that mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. Mattresses shall be made specifically for the size crib or play yard in which they are placed. LPM and LPA advised that cribs or play yards shall be free from all loose articles, objects, bumper pads shall not be used, and there shall be no objects hanging above or attached to the side of the crib. LPM and LPA reviewed the Safe Sleep 15-minute check and the LIC 9227 Individual Sleep Plan.

Per applicant, there are no firearms or other weapons located in the home.

LPM and LPA observed a fireplace barricaded with a secured metal screen making it inaccessible to children in care.

Kitchen was observed with sharp utensils and knives rendered inaccessible. Kitchen was observed to be clean. Kitchen, dining room and living room was observed to be an open floor plan. Kitchen cabinets were observed with child safety latches. Applicant will provide food/snack to children in her care.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: KOTANJYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700077
VISIT DATE: 05/19/2023
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Bathrooms were observed to be clean with toilet and faucet safe and operable. Bathtub and shower are free of hazards. LPM and LPA advised shampoos, mouthwash, soap, medication, perfumes, razor blades, air freshener, nail polish/ remover shall be inaccessible to children.

Outdoor play area is the back yard. LPM and LPA advised that outdoor play areas shall be supervised by the applicant. LPM and LPA observed two dogs on the side of the home in a dog run which has a gate that is locked with a pad lock. Dog vaccinations have been provided and are on file. Per applicant, the dogs belong to her daughter and she is temporarily housing them.

When a child is ill, they will be separated from the other children. Isolation area will be located in bedroom #1. Home was observed with a first aid kit located in a kitchen cabinet above the refrigerator.

Smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

LPM and LPA advised that fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Safety Commission shall not be used for children in care or accessible to children in care.

LPA provided applicant with the following required postings: LIC610A Emergency Disaster Plan, PUB 394 Notification of Parents’ Rights Poster, and LIC 9148 Earthquake Preparedness Checklist. LPA advised that once licensed, the facility license shall be posted. LPA advised that all LIC9213 Notice of Site Visits shall be posted for 30 days after each site visit. LPA advised that any licensing report documenting a Type A citation must be posted for 30 days. LPA advised that a disaster drill log shall be posted with disaster drills completed at lease every six months.

LPA reviewed LIC 9040 Child Care Roster and LIC282 Affidavit Regarding Liability Insurance with applicant.

LPA advised that the applicant shall reveal each family child care license number in all advertisements in accordance with Health and Safety Code Section 1596.861.

pg 3 of 5

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: KOTANJYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700077
VISIT DATE: 05/19/2023
NARRATIVE
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LPA advised that per FCCH regulation, Section 102417(a) Operation of A Family Child Care Home: The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

Applicant 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 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 Applicant Anna Kotanjyan 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: 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.

Entrance Checklist was provided to the applicant.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: KOTANJYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700077
VISIT DATE: 05/19/2023
NARRATIVE
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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.

The following corrections are needed before a licensure will be considered. Corrections are due by 06/19/2023:

  • Proof of purchase of tables, chairs and napping equipment for children and proof of where items are placed in the home.
  • Applicant will provide proof the turf in the backyard is secured on the cement.
  • Applicant will provide proof of purchase (receipt) of the fire extinguisher and the placement of the fire extinguisher.
  • Updated Yard Facility Sketch.
  • Narek Mesropyan TB test.
  • Cork board to be used for parent notification (parent board).
  • Incidental Medical Services Plan will be provided

An exit interview was conducted with the above items discussed and this report was provided to the applicant, Anna Kotanjyan. Final license determination will be made upon review by the Licensing Program Manager and corrections of the above issues.

pg 5 of 5

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5