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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700116
Report Date: 05/17/2023
Date Signed: 05/17/2023 11:01:09 AM

Document Has Been Signed on 05/17/2023 11:01 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:SARGSYAN FAMILY CHILDCAREFACILITY NUMBER:
195700116
ADMINISTRATOR:VARDUHI SARGSYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 861-5885
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/17/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:01 AM
MET WITH:Varduhi SargsyanTIME COMPLETED:
11:10 AM
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On 05/17/2023 Licensing Program Analysts Maria Rendon and Deborah Lowe met with Applicant, Varduhi Sargsyan. The purpose of the visit was an announce pre-licensing inspection at the home located at 11539 Ruffner Ave, Granada Hills, CA 91344 to ensure that health, safety and personal rights as requires by Title 22 and Health and Safety Regulations governing California Child Care Homes will be met.

This is an application for a Large Family Child Care Home and applicant is requesting a capacity of 14 children, ages 0 to 14 years old. Copy of Deed is on file, reflecting applicant has control of property. The Family Child Care Home will operate Monday – Saturday 7:00 a.m. – 9:00 p.m. The fire clearance was approved on 05/05/2023. Currently living in the home is the applicant and 2 minor children.

All areas identified on the facility sketch were identified, including but not limited to, off limit areas. This is a two-story home that consist of: (first floor) 2 bedrooms labeled #1 and #2, bathroom, kitchen, dining area, living room, attached garage and laundry room; (second floor) 2 bedrooms labeled #3 and #4, bathroom hallway and stairs. The children in care will use rooms located in the first floor which are, bedroom #1 and #2, bathroom and will have access to the kitchen in order to have access to the back yard. The dining area, living room area, laundry room, garage and all the rooms located on the second floor will be off limits. There is a child’s safety gate at the bottom of the stairway to prevent children from going upstairs.

LPAs observed a working carbon monoxide detector in the home located in the kitchen, LPAs were able to hear a successful test. Smoke detectors are located in bedroom #1 and #2. Fire extinguisher 2A10BC was observed, located in the hallway between bedroom #1 and #2, and was purchased on 05/03/2023. 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. LPAs observed safe toys, play equipment, and materials. LPAs verified the home has a working telephone service.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maria Rendon
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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 9
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: SARGSYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700116
VISIT DATE: 05/17/2023
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LPAs advised, baby walkers, bouncer, Johnny jumper, trampoline, saucer chairs are not permitted.

LPAs observed cleaning compounds and detergents inaccessible to children by use of child safety latches. LPAs advised poisons shall be locked with a key or a combination lock.

Cots were observed for napping. LPAs advised, 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 a play yard/crib. LPAs advised, the placement of cribs or play yards shall not hinder entrance or exit to and from the space where infants are sleeping. LPAs advised, 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. LPAs advised, 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. LPAs review Safe Sleep 15-minute check and the LIC 9227 Individual Sleep Plan.

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

LPAs observed a fireplace with a wooden board secured in the opening of the fireplace and barricaded with an unsecured metal screen making it inaccessible to children in care.

Home was observed with stairs, LPAs observed the stairs to be barricaded with the use of a child gate.

Kitchen was observed with sharp utensils, matches, and open bottles of alcohol are 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.

Bathrooms were observed to be clean with toilet and faucet safe and operable. Shower was observed to be free of hazards. LPAs advised shampoos, mouthwash, soap, medication, perfumes, razor blades, air freshener, nail polish/ remover shall be inaccessible to children.

Outdoor area is located in the back yard. LPAs observed the back yard to be a U shape around the home. LPAs advised, outdoor play areas shall be supervised by the licensee. LPAs observed the backyard to have gates on both sides on the home (north and south). The air conditioner unit was observed on the south side of the

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

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 9
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: SARGSYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700116
VISIT DATE: 05/17/2023
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backyard and meter on the north side of the home. LPAs advised to make both areas inaccessible to children.

When a child is ill, they will be separated from the other children. Isolation area will be located in the hallway nook located near bedroom #2. Home was observed with a first aid kit.

LPAs observed a dog in the home. Per applicant dog will remain in the laundry room while children are under her care. The laundry room was observed to be inaccessible to children with a door and child gate.

LPAs reviewed staffing ratio and capacity with applicant. LPAs advised per CC Regulation 102416.5(e) Staffing Ratio and Capacity (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

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).

LPA advised, 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.

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

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

LPAs advised the licensee shall reveal each child care center license number in all advertisements in accordance with Health and Safety Code Section 1596.861.

LPAs advised per CC Regulation 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

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

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC809 (FAS) - (06/04)
Page: 3 of 9
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: SARGSYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700116
VISIT DATE: 05/17/2023
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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.

LPAs 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 Varduhi Sargsyan 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



LPAs 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.

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.

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

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC809 (FAS) - (06/04)
Page: 4 of 9
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: SARGSYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700116
VISIT DATE: 05/17/2023
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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 06/02/2023:

  • Make Outdoor Meter located on north side of the back yard inaccessible to children.
  • Make air conditioner unit located on south side of the back yard inaccessible to children.
  • Applicant will purchase at least one play yard and provide proof of purchase to LPA.
  • Proof of dog vaccinations/rabies.

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

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

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC809 (FAS) - (06/04)
Page: 5 of 9