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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700260
Report Date: 11/04/2024
Date Signed: 11/04/2024 03:45:15 PM

Document Has Been Signed on 11/04/2024 03:45 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:GEVORGYAN FAMILY CHILD CAREFACILITY NUMBER:
195700260
ADMINISTRATOR/
DIRECTOR:		ANAIT GEVORGYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 438-8221
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/04/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Anait Gevorgyan, ApplicantTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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Pre-Licensing Visit Conducted In Armenian
Licensing Program Analyst (LPA) Silva Garibyan conducted a change of location pre-licensing inspection on 11/04/2024 at 12:15 PM. LPA met with Anait Gevorgyan, applicant who guided analyst on a tour of the facility. Applicant is applying for a Large Family Child Care Home with a capacity of 14 children, ages 0 to 13 years old. The applicant does not meet the following requirement: 102371(a): A fire safety clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal shall be required for a large family child care home. Applicant provided a new Application for a Family Child Care Home License for small (8) at the time of the visit. Per applicant operation hours will be Monday to Friday 8:00AM-6:00PM. Applicant will care for children from newborn to 13 years of age. Applicant stated that a cell phone with active service in the home will be the main contact number while children are in care. All areas identified on the facility sketch were inspected, including but not limited to off limit areas. This is a single story home that consists of three bedrooms, two bathrooms, living/dining room, kitchen, and converted attached garage. Parents and children will use the main entry door leading to the hall way. All electrical outlets in the home were covered. Applicant has designated Bedroom(1), Bedroom(2), Bedroom (3), Bathroom (2), Back Yard, and attached garage as OFF LIMIT to the children in care. LPA observed bedroom doors with key lock knobs making off limit areas inaccessible. Page 1
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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: GEVORGYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700260
VISIT DATE: 11/04/2024
NARRATIVE
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Kitchen cabinets were observed and inspected. The stove, refrigerator, sink and counter space area were observed and inspected. Knifes and sharp objects observed to be made inaccessible to the children in care. The bathroom is in the hallway. A toilet, a sink, and a shower was observed. The bathroom was observed to be free of hazards.

Children will utilize the front yard to play. The yards are fully fenced with no bodies of water. Applicant is stating that when children are having outside time she will ensure 100% supervision and never leave children unattended. There is no pool, spa or other bodies of water on the premises. 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 10/28/2024). The applicant has current pediatric CPR/First Aid training completed on 05/23/2023.

Living/Dining Room was observed to have children size tables, chairs, crib, eight cots, and variety of age appropriate materials. Per Applicant, additional play yards/cribs for infants will be purchased upon admission. LPA observed emergency water and first aid kit in the hall way closet. Children will eat and sleep in the Living/Dining room. LPA observed applicant test the carbon monoxide/smoke detectors in the living room. Per applicant, there are no weapons or firearms of any kind in the facility at this time. LPA did not observe any weapons. LPA observed a fire extinguisher (3A40BC, Date Of Purchase: 10/28/2024) mounted in the kitchen. There are no stairs in this home.

Applicant has the required documents posted in the FCCH: Emergency Disaster Plan (LIC610A), Notification of Parents' Rights Poster (PUB 394), If You see Something Say Something poster, Safe Sleep poster. Page 2

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

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
LIC809 (FAS) - (06/04)
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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: GEVORGYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700260
VISIT DATE: 11/04/2024
NARRATIVE
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Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Residential Lease/Rental Agreement was provided.

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.


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.

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

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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: GEVORGYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700260
VISIT DATE: 11/04/2024
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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 2/14/2024, 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.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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: GEVORGYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700260
VISIT DATE: 11/04/2024
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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 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, Anait Gevorgyan.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5