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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700302
Report Date: 05/24/2024
Date Signed: 05/24/2024 11:21:30 AM

Document Has Been Signed on 05/24/2024 11:21 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:MKHITARYAN FAMILY CHILD CAREFACILITY NUMBER:
195700302
ADMINISTRATOR/
DIRECTOR:		MARIYETTA MKHITARYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 893-9447
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/24/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:30 AM
MET WITH:Maryetta Mkhitaryan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Pre-Licensing Visit Conducted In Armenian
Licensing Program Analyst (LPA) Silva Garibyan conducted a pre-licensing change of location inspection on 05/24/2024 at 7:30AM. LPA met with Mariyetta Mkhitaryan, Licensee, who guided analyst on a tour of the facility. Home is located on a lot with a front house with address: 5437 Vantage Ave, Valley Village, CA 91606. The house has access to the licensee's yard area. Licensee is requesting a large family child care home license with a capacity of 14. Licensee is currently licensed as a large Family Child Care Home under facility # 197418057 (Effective Date: 01/11/2012). Licensee has installed the pull fire alarm that is required for large Family Child Care Homes and have an approved fire clearance. Per Licensee operation hours will be Monday to Friday from 8:00 am to 5:30 pm. Licensee states she will care for children newborn to 12 years of age. Entrance Checklist was provided to the applicant. Applicant stated that a cell phone with active service in the home will be the main contact number while children are in care. Family members residing in the home include Licensee only. Occupants of 5435 Vantage Ave and 5437 Vantage Ave have a criminal record clearance on file. The home appeared to be clean, safe and well ventilated with telephone service.

All areas identified on the facility sketch were inspected. This is a single story home that consists of 2 bedrooms, 2 bathrooms, living room, kitchen, and laundry area. Parents and children will use the main entry door leading to the living room. Page 1 of 5

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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: MKHITARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700302
VISIT DATE: 05/24/2024
NARRATIVE
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Safety gate and shelves are installed to make the kitchen inaccessible. LPA observed child safety latches on all kitchen cabinet doors and drawers. Bedrooms were observed and inspected. There is no pool, spa or other bodies of water on the premises.

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 emergency water and first aid kit in Bedroom(2)'s closet. Living room was observed to have four children size tables, 12 chairs, and a variety of age appropriate materials. Bedroom(1) was observed to have 12 napping cots and one crib. Children will eat in Living room and sleep in Bedroom (1). LPA observed licensee test the carbon monoxide/ smoke detector in all rooms. LPA observed a fire extinguisher (2A10BC, DOS: 03/27/2024) mounted in the hall way. All electrical outlets in the home were covered. There are no stairs in this home.

Bathroom(1) that children will use is in the hall way. A toilet, a sink, and a shower was observed. The bathroom was observed to be free of hazards. Bathroom (2) is in Bedroom(2) (sink, toilet, shower) and observed to be free of hazards. Children will utilize the back yard to play. The yard is fully fenced with no bodies of water. Applicant is stating that when children are having outside time he will ensure 100% supervision and never leave children unattended.

Applicant has submitted a disaster plan. Mandated Reporter training (completed on 02/13/2023). The applicant has current pediatric CPR/First Aid training completed on 03/27/2024.

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

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
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: MKHITARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700302
VISIT DATE: 05/24/2024
NARRATIVE
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 Licensee 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.

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).



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

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
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: MKHITARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700302
VISIT DATE: 05/24/2024
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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-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 4/08/2024, 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.
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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
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: MKHITARYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700302
VISIT DATE: 05/24/2024
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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 licensee, Mariyetta Mkhitaryan.

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

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
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