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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700127
Report Date: 08/25/2023
Date Signed: 08/25/2023 12:05:01 PM

Document Has Been Signed on 08/25/2023 12:05 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:MONOSYAN FAMILY CHILDCAREFACILITY NUMBER:
195700127
ADMINISTRATOR:HERMINE MONOSYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 823-0634
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/25/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Hermine Monosyan, ApplicantTIME COMPLETED:
12:05 PM
NARRATIVE
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Pre-Licensing Visit Conducted In Armenian
On 08/25/23, at 08:00 A.M., Licensing Program Analyst (LPA) Silva Garibyan arrived at the facility, which is located at 7006 Willis Ave, Van Nuys, CA 91405. LPA was greeted and let into the residence by applicant, to whom the purpose of the inspection was announced. Applicant was informed that we are going to tour the home for a pre-licensing requirement per Title 22 regulations and health and safety standard code requirements. 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. Present during today's inspection was Licensee and licensee's daughter/assistant

Applicant is applying for a Large Family Child Care Home with a capacity of 14 children, infant to 13 years old. The Fire clearance was granted on 08/16/2023 by LA City Fire Prevention Bureau (inspector Shawn Connolly). The licensee has installed the pull fire alarm that is required for large Family Child Care Homes. Applicant’s proposed days and hours of operation are Monday – Friday, 7:30 AM - 10:00 PM. Currently living in the home are applicant, spouse, applicant's adult son and daughter. Applicant's home is a single story 4 bedroom, 2 bathroom home with living room, kitchen, attached carport, and detached converted garage with attached storage room. The detached garage has not been fully converted and applicant is fully aware that children may not eat or sleep in the garage. Children will eat and sleep in the living room. Page 1 of 5

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
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: MONOSYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700127
VISIT DATE: 08/25/2023
NARRATIVE
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 The main entry door will be used to enter the facility. Three bedrooms (2, 3, and 4), the storage room adjacent to the garage, and the bathroom near the master bedroom are off limits to the children in care. Children will eat and sleep in the living room and in Bedroom 1. The children will have access to Bathroom 1 located in the hall way near Bedroom 1.

Applicant has submitted a disaster plan. The applicant has completed preventive health and safety/Childhood Nutrition/ Lead Exposure Prevention and Mandated Reporter training (completed on 07/26/2022). The applicant has current pediatric CPR/First Aid training completed on 05/01/2022.

The living room and the converted garage was observed to have children size tables and chairs and a variety of age appropriate materials. LPA observed napping cots, a play yard, and emergency water and first aid kit ( in the closed by Bedroom 1). LPA observed applicant test the carbon monoxide and smoke detector in the hall way. All electrical outlets in the home were covered. There is no pool, spa or other bodies of water on the premises. Bedrooms and the bathrooms were inspected. The bedrooms and the bathrooms were 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. LPA observed toys and furniture that were age appropriate and in good repair.

LPA toured the backyard and found it to be fully fenced. Children's outdoor play equipment and toys are age appropriate and in good repair. Applicant is stating that when children are having outside time he will ensure 100% supervision and never leave children unattended. LPA observed a storage shed in the back yard. The shed was observed to be locked. Page 2 of 5

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

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
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: MONOSYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700127
VISIT DATE: 08/25/2023
NARRATIVE
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 Licensee has the following documents posted in the facility; Notification of Parents' Rights Poster (PUB394), Emergency Disaster Plan (LIC610a), Lead Poisoning Facts/Potential Sources Of Lead/Effects Of Lead Exposure.

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 owns the home. The applicant provided proof of control of property and demonstrated control of property at the above address by presenting the Property Tax Statement.

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.

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

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
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: MONOSYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700127
VISIT DATE: 08/25/2023
NARRATIVE
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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-and-resources/safe-sleep, as an additional resource. LPA also informed [applicant, licensee, or facility representative] 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 04/28/2023, 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.
MyChildCarePlan.org--Child Care Centers and Family Child Care Home
[Applicant, or Licensee] 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.

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

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
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: MONOSYAN FAMILY CHILDCARE
FACILITY NUMBER: 195700127
VISIT DATE: 08/25/2023
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Exit interview conducted and report was reviewed with the applicant, Hermine Monosyan.
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-care-licensing/subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5