<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700105
Report Date: 07/19/2023
Date Signed: 07/19/2023 11:37:10 AM

Document Has Been Signed on 07/19/2023 11:37 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:KHACHATRYAN FAMILY CHILD CAREFACILITY NUMBER:
195700105
ADMINISTRATOR:MANIK KHACHATRYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 371-5115
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/19/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Manik Khachatryan, ApplicantTIME COMPLETED:
12:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Pre-Licensing Visit Conducted In Armenian
On 07/19/23, at 08:00 A.M., Licensing Program Analyst (LPA) Silva Garibyan arrived at the facility, which is located at 11912 Clonlee Ave, Granada Hills, CA 91344. LPA was greeted and let into the residence by applicant Manik Khachatryan, to whom the purpose of the inspection was announced. The purpose of the inspection is due to an application received for a relocation of a large family childcare license. LPA conducted an 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 Large Family Child Care Home with a capacity of 14 children, ages 0 to 13 years old. The Fire clearance was granted on 07/07/2023 by LA City Fire Prevention Bureau (inspector Cindy Struck). Applicant’s proposed days and hours of operation are Monday – Sunday, for 24 hours. Currently living in the home are applicant, spouse, and her minor daughter (10 years old). Applicant's home is a single story 6 bedroom, 4 bathroom home with living room, dining room, family room, kitchen, nook, laundry room, and detached garage with attached storage/kitchenette. It was explained to the applicant that food can not be stored or prepared in the storage/kitchenette. Food will be stored and prepared in the main house where care and supervision will take place. Page 1 of 6

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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 6
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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700105
VISIT DATE: 07/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 The main entry door will be used to enter the facility. Four bedrooms and two bathrooms on the right of the entry and the garage/storage room are off limits to the children in care. Children will eat and sleep in the living room, family room, dining room, and in two bedrooms on the left side of the house. There is an in-ground pool on the premises located in the back yard of home with black mesh between the pool and the home. Pool was inspected and fence was measured by applicant during today’s visit. LPA observed the pool fencing to be 5 feet high. One side of the pool is enclosed by the mesh fence. The three sides are enclosed by the property walls. The black mesh pool fencing was observed with metal post measuring 35 inches apart with black mesh secured in-between. Post was observed to be secured; LPA was unable to pull out of ground. Black mesh material was observed secured to each post. Bottom of mesh material located near the hard ground was measured with a space less than an inch. Entrance gate to the pool was observed to swing away from the pool. When opened and released the gate self-latched. Self-latching device was observed with a key locking system. The mesh fencing is sturdy and capable of withstanding the impact of children's toys including bicycles. There are no other bodies of water on the premises. Pool does meet title 22 regulation code 102417 (g)(5)(A).

Applicant has a small dog. Applicant has submitted a disaster plan and demonstrated control of property at the above address by presenting Grand Deed. The applicant has completed preventive health and safety/Childhood Nutrition/ Lead Exposure Prevention and Mandated Reporter training (completed on 03/03/2023). The applicant has current pediatric CPR/First Aid training completed on 03/09/2022.

Page 2 of 6

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700105
VISIT DATE: 07/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Bedrooms were observed and inspected. Applicant has designated Bedroom 1, 2, 3, and 4 and bathroom 1 and bathroom 2 as OFF LIMIT to the children in care. LPA observed the door leading to the hall way with safety knob making the entire right side of the house inaccessible. The bathroom that children will use is in the hall way near the entry door. A toilet and a sink were observed. The bathroom was observed to be free of hazards.

All bottom cabinets and drawers in the kitchen were observed to have safety latches.. Stove was observed to have children’s safety latches making them inaccessible to the children in care.

Applicant confirmed no fire arms or weapons are in the home. Applicant is stating that when children are having outside time she will ensure 100% supervision and never leave children unattended.

There are sliding doors from the family room leading to the back yard/patio area. The patio area is cemented. The family room was observed to have children size tables and chairs and a variety of age appropriate materials. LPA observed napping cots, and emergency water and first aid kit ( in the closet in the hall way). LPA observed applicant test the carbon monoxide and smoke detector in the hall way. LPA observed a fire extinguisher (3A40BC) mounted in the kitchen. All electrical outlets in the home were covered. The fireplaces located in the living room and in the family room is made inaccessible by a screens.

Page 3 of 6

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700105
VISIT DATE: 07/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA observed a parent board in the day care room. 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), Lead Poisoning Facts/Potential Sources Of Lead/Effects Of Lead Exposure. 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.

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, 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.


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) or (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. Page 4 of 6
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700105
VISIT DATE: 07/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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.
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-andresources/safe-sleep, as an additional resource.
LPA also informed applicant 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.
On this date, 07/19/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.
Applicant was informed of the MyChildCarePlan.org site, 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.

Page 5 of 6
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700105
VISIT DATE: 07/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication

Exit interview conducted and report was reviewed with the applicant, Manik Khachatryan.

Final license determination will be made upon review by the Licensing Program Manager.


Page 6 of 6
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6